Cohort studyindependent cross-checkabstract checked I-ORG-117 standard review

Blood clots and sepsis after spleen removal in ITP

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia.

Overview

Boyle S et al.. Blood 2013 · PMID 23637127 · DOI 10.1182/blood-2012-12-467068

Patients whose spleen was removed had more blood clots (4.3% vs 1.7%) and more sepsis than similar patients who kept their spleen.

Does the study support the specific claim? Yes · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Measure clot and sepsis risk after splenectomy in ITP
How was the study done?: Cohort study
How many people, animals or samples were studied?: 9976 ITP patients
What was actually found?: Higher VTE and sepsis risk, early and late
How large was the observed effect?: Late VTE HR 2.7
What do the results mean in everyday life?: Splenectomy has lasting risks to weigh
What are the study's limitations?: Administrative data
What does it say about Elawady's specific claim?: Supports the VTE part of the claim
Do the results apply to Germany and Europe?: Applicable
What can explicitly not be concluded from this study?: Not more than about a decade of data

Authors: Boyle S et al.
Journal: Blood
Year: 2013
Identifier: PMID 23637127 DOI 10.1182/blood-2012-12-467068
Verification: verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Not stated in abstract.

Risks of venous thromboembolism and sepsis after splenectomy in ITP.

Study design: Cohort study – Retrospective cohort (California discharge data) of patients with immune thrombocytopenia
Population: 9976 patients with ITP, 1762 splenectomised
Country: USA (California)
Period: Not stated in abstract
Sample size: 9976 (1762 splenectomy)
Inclusion and exclusion criteria: ITP diagnosis

Exposure / intervention: Splenectomy
Comparator: ITP patients without splenectomy
Endpoints: Abdominal VTE, VTE (DVT/PE), sepsis
Statistical methods: Cumulative incidence; adjusted HR early (<90 d) and late (>=90 d)

Results: Abdominal VTE 1.6% vs 1%; VTE 4.3% vs 1.7%. Abdominal VTE HR 5.4 (2.3-12.5) early, 1.5 (0.9-2.6) late. VTE HR 5.2 (3.2-8.5) early and 2.7 (1.9-3.8) late. Sepsis 11.1% vs 10.1%; adjusted HR 3.3 (2.4-4.6) early and 1.6 or 3.1 late depending on comorbidities.
Absolute risks: VTE cumulative incidence 4.3% vs 1.7%.
Authors' conclusion: ITP patients after splenectomy are at increased risk of abdominal VTE, VTE and sepsis.

Orienting tool: ROBINS-E
Type of assessment: simplified assessment (abstract only)
Full formal assessment: no
Overall risk of bias: some concerns
Rationale: Comparison within the same disease reduces confounding by indication.

VTE absolute difference 2.6 points, NNH about 38 (stats/C-ORG-12_13_splenectomy.py).

Shows a lasting VTE and sepsis excess after splenectomy compared with patients with the same disease.

Rørholt 2017 (A-ORG-17): MI and pulmonary hypertension explained by underlying disease.

US data; biology transferable.

Supports the VTE part of C-ORG-13 (late HR 2.7), within a disease-matched comparison.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	some concerns
Precision of results	moderate
Directness	direct
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Very long-term (>10 years) VTE risk.