LONG-TERM RISK OF CARDIOVASCULAR EVENTS FOLLOWING SPLENECTOMY ? A DANISH POPULATION-BASED COHORT STUDY
(Abstract release date: 05/19/16)
EHA Library. Rørholt M. 06/12/16; 135320; S826
Ms. Marianne Rørholt
Contributions
Contributions
Abstract
Abstract: S826
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Room H4
Background
The most frequent medical indications for splenectomy are hematological disorders and although, splenectomy has been used for decades to treat various medical and surgical conditions, it is known to be associated with various short and long term complications. An increased risk of venous thromboembolism following splenectomy is well documented while data on long-term risk of cardiovascular events following splenectomy are scarce.
Aims
This study aimed to assess risk of acute myocardial infarction (MI), pulmonary arterial hypertension (PAH), and stroke following splenectomy among patients splenectomised for a variety of indications compared with the risks in the general population and to determine whether these events were related to the procedure or to the underlying pathology by comparing the risk among patients who underwent splenectomy with that among non-splenectomised patients with similar medical conditions.
Methods
We used population-based medical databases to identify patients splenectomised in Denmark during 1996-2012, and constructed an age- and sex-matched general population comparison cohort and a disease-matched comparison cohort. We classified splenectomised patients into 8 subgroups based on the underlying indication for splenectomy: (1) traumatic rupture of the spleen; (2) idiopathic thrombocytopenic purpura (ITP); (3) unspecified thrombocytopenia; (4) hematopoietic cancer; (5) hereditary haemolytic anaemia; (6) abdominal cancer; (7) splenomegaly/other splenic diseases; (8) no indication recorded. We computed 5-year cumulative incidence rates (treating death as a competing event) and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) of MI, PAH, and stroke for the 3 cohorts. We controlled for age, sex, and pre-existing chronic obstructive pulmonary disease, obesity, pulmonary embolism and heart failure.
Results
We identified 5,306 splenectomised, 53,060 population comparisons and 11,651 disease-matched comparisons. The most frequent indications for splenectomy were traumatic rupture (19.5%), abdominal cancers (16.6%), hematopoietic cancers (7.9%), and ITP (7.1%). Within 5 years of follow-up (table), 1.28% of splenectomised patients had MI compared with 1.75% in the general population, yet corresponding aHR was 1.26 (95%CI 1.02-1.55). The 5-year cumulative incidence of PAH was 0.33% among splenectomised and 0.16% [aHR 3.28(95%CI 1.93-5.58)] in the general population, and for stroke 3.34% versus 2.62% [aHR 2.05(95%CI 1.78-2.36)]. When comparing the splenectomised cohort with the disease-matched cohort, only stroke-risk was elevated, occurring in 2.99% of the splenectomised versus 2.32% in disease-matched [aHR 1.49(95% CI 1.23-1.81)].
Conclusion
The higher risk of stroke in splenectomised compared with the disease-matched and the general population indicates that splenectomy increases the risk of stroke. Risk of MI and PAH was not higher in splenectomised patients than in disease-matched comparisons, indicating that the higher risk in splenectomised patients compared with the general population can largely be explained by the underlying indication.
Session topic: Platelet disorders 2
Keyword(s): Myocardial infarction, Pulmonary hypertension, Splenectomy, Stroke
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Room H4
Background
The most frequent medical indications for splenectomy are hematological disorders and although, splenectomy has been used for decades to treat various medical and surgical conditions, it is known to be associated with various short and long term complications. An increased risk of venous thromboembolism following splenectomy is well documented while data on long-term risk of cardiovascular events following splenectomy are scarce.
Aims
This study aimed to assess risk of acute myocardial infarction (MI), pulmonary arterial hypertension (PAH), and stroke following splenectomy among patients splenectomised for a variety of indications compared with the risks in the general population and to determine whether these events were related to the procedure or to the underlying pathology by comparing the risk among patients who underwent splenectomy with that among non-splenectomised patients with similar medical conditions.
Methods
We used population-based medical databases to identify patients splenectomised in Denmark during 1996-2012, and constructed an age- and sex-matched general population comparison cohort and a disease-matched comparison cohort. We classified splenectomised patients into 8 subgroups based on the underlying indication for splenectomy: (1) traumatic rupture of the spleen; (2) idiopathic thrombocytopenic purpura (ITP); (3) unspecified thrombocytopenia; (4) hematopoietic cancer; (5) hereditary haemolytic anaemia; (6) abdominal cancer; (7) splenomegaly/other splenic diseases; (8) no indication recorded. We computed 5-year cumulative incidence rates (treating death as a competing event) and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) of MI, PAH, and stroke for the 3 cohorts. We controlled for age, sex, and pre-existing chronic obstructive pulmonary disease, obesity, pulmonary embolism and heart failure.
Results
We identified 5,306 splenectomised, 53,060 population comparisons and 11,651 disease-matched comparisons. The most frequent indications for splenectomy were traumatic rupture (19.5%), abdominal cancers (16.6%), hematopoietic cancers (7.9%), and ITP (7.1%). Within 5 years of follow-up (table), 1.28% of splenectomised patients had MI compared with 1.75% in the general population, yet corresponding aHR was 1.26 (95%CI 1.02-1.55). The 5-year cumulative incidence of PAH was 0.33% among splenectomised and 0.16% [aHR 3.28(95%CI 1.93-5.58)] in the general population, and for stroke 3.34% versus 2.62% [aHR 2.05(95%CI 1.78-2.36)]. When comparing the splenectomised cohort with the disease-matched cohort, only stroke-risk was elevated, occurring in 2.99% of the splenectomised versus 2.32% in disease-matched [aHR 1.49(95% CI 1.23-1.81)].
Conclusion
The higher risk of stroke in splenectomised compared with the disease-matched and the general population indicates that splenectomy increases the risk of stroke. Risk of MI and PAH was not higher in splenectomised patients than in disease-matched comparisons, indicating that the higher risk in splenectomised patients compared with the general population can largely be explained by the underlying indication.
Session topic: Platelet disorders 2
Keyword(s): Myocardial infarction, Pulmonary hypertension, Splenectomy, Stroke
Abstract: S826
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Room H4
Background
The most frequent medical indications for splenectomy are hematological disorders and although, splenectomy has been used for decades to treat various medical and surgical conditions, it is known to be associated with various short and long term complications. An increased risk of venous thromboembolism following splenectomy is well documented while data on long-term risk of cardiovascular events following splenectomy are scarce.
Aims
This study aimed to assess risk of acute myocardial infarction (MI), pulmonary arterial hypertension (PAH), and stroke following splenectomy among patients splenectomised for a variety of indications compared with the risks in the general population and to determine whether these events were related to the procedure or to the underlying pathology by comparing the risk among patients who underwent splenectomy with that among non-splenectomised patients with similar medical conditions.
Methods
We used population-based medical databases to identify patients splenectomised in Denmark during 1996-2012, and constructed an age- and sex-matched general population comparison cohort and a disease-matched comparison cohort. We classified splenectomised patients into 8 subgroups based on the underlying indication for splenectomy: (1) traumatic rupture of the spleen; (2) idiopathic thrombocytopenic purpura (ITP); (3) unspecified thrombocytopenia; (4) hematopoietic cancer; (5) hereditary haemolytic anaemia; (6) abdominal cancer; (7) splenomegaly/other splenic diseases; (8) no indication recorded. We computed 5-year cumulative incidence rates (treating death as a competing event) and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) of MI, PAH, and stroke for the 3 cohorts. We controlled for age, sex, and pre-existing chronic obstructive pulmonary disease, obesity, pulmonary embolism and heart failure.
Results
We identified 5,306 splenectomised, 53,060 population comparisons and 11,651 disease-matched comparisons. The most frequent indications for splenectomy were traumatic rupture (19.5%), abdominal cancers (16.6%), hematopoietic cancers (7.9%), and ITP (7.1%). Within 5 years of follow-up (table), 1.28% of splenectomised patients had MI compared with 1.75% in the general population, yet corresponding aHR was 1.26 (95%CI 1.02-1.55). The 5-year cumulative incidence of PAH was 0.33% among splenectomised and 0.16% [aHR 3.28(95%CI 1.93-5.58)] in the general population, and for stroke 3.34% versus 2.62% [aHR 2.05(95%CI 1.78-2.36)]. When comparing the splenectomised cohort with the disease-matched cohort, only stroke-risk was elevated, occurring in 2.99% of the splenectomised versus 2.32% in disease-matched [aHR 1.49(95% CI 1.23-1.81)].
Conclusion
The higher risk of stroke in splenectomised compared with the disease-matched and the general population indicates that splenectomy increases the risk of stroke. Risk of MI and PAH was not higher in splenectomised patients than in disease-matched comparisons, indicating that the higher risk in splenectomised patients compared with the general population can largely be explained by the underlying indication.
Session topic: Platelet disorders 2
Keyword(s): Myocardial infarction, Pulmonary hypertension, Splenectomy, Stroke
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Room H4
Background
The most frequent medical indications for splenectomy are hematological disorders and although, splenectomy has been used for decades to treat various medical and surgical conditions, it is known to be associated with various short and long term complications. An increased risk of venous thromboembolism following splenectomy is well documented while data on long-term risk of cardiovascular events following splenectomy are scarce.
Aims
This study aimed to assess risk of acute myocardial infarction (MI), pulmonary arterial hypertension (PAH), and stroke following splenectomy among patients splenectomised for a variety of indications compared with the risks in the general population and to determine whether these events were related to the procedure or to the underlying pathology by comparing the risk among patients who underwent splenectomy with that among non-splenectomised patients with similar medical conditions.
Methods
We used population-based medical databases to identify patients splenectomised in Denmark during 1996-2012, and constructed an age- and sex-matched general population comparison cohort and a disease-matched comparison cohort. We classified splenectomised patients into 8 subgroups based on the underlying indication for splenectomy: (1) traumatic rupture of the spleen; (2) idiopathic thrombocytopenic purpura (ITP); (3) unspecified thrombocytopenia; (4) hematopoietic cancer; (5) hereditary haemolytic anaemia; (6) abdominal cancer; (7) splenomegaly/other splenic diseases; (8) no indication recorded. We computed 5-year cumulative incidence rates (treating death as a competing event) and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) of MI, PAH, and stroke for the 3 cohorts. We controlled for age, sex, and pre-existing chronic obstructive pulmonary disease, obesity, pulmonary embolism and heart failure.
Results
We identified 5,306 splenectomised, 53,060 population comparisons and 11,651 disease-matched comparisons. The most frequent indications for splenectomy were traumatic rupture (19.5%), abdominal cancers (16.6%), hematopoietic cancers (7.9%), and ITP (7.1%). Within 5 years of follow-up (table), 1.28% of splenectomised patients had MI compared with 1.75% in the general population, yet corresponding aHR was 1.26 (95%CI 1.02-1.55). The 5-year cumulative incidence of PAH was 0.33% among splenectomised and 0.16% [aHR 3.28(95%CI 1.93-5.58)] in the general population, and for stroke 3.34% versus 2.62% [aHR 2.05(95%CI 1.78-2.36)]. When comparing the splenectomised cohort with the disease-matched cohort, only stroke-risk was elevated, occurring in 2.99% of the splenectomised versus 2.32% in disease-matched [aHR 1.49(95% CI 1.23-1.81)].
Conclusion
The higher risk of stroke in splenectomised compared with the disease-matched and the general population indicates that splenectomy increases the risk of stroke. Risk of MI and PAH was not higher in splenectomised patients than in disease-matched comparisons, indicating that the higher risk in splenectomised patients compared with the general population can largely be explained by the underlying indication.
Session topic: Platelet disorders 2
Keyword(s): Myocardial infarction, Pulmonary hypertension, Splenectomy, Stroke
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