Does Splenectomy Prevent Increased Valve Disease Risk in ITP?

A recent publication from Fathima Haseefa and colleagues suggested that immune thrombocytopenia (ITP) was independently associated with risk of aortic valve disease (AVD). Subsequently, the team investigated if patients with ITP who underwent splenectomy still had increased risk. Notably, Haseefa reported patients did not show an increased risk for AVD following splenectomy. Their findings were published in the American Journal of Blood Research.

The study enrolled patients in the Nationwide Inpatient Sample population between 2005 and 2014, a randomly selected 10-year period. Using International Classification of Diseases, Ninth Revision codes, researchers identified a total of 108,434 patients with ITP, of which 4282 had undergone a splenectomy. Univariate and multivariate analyses were adjusted for baseline features.

Splenectomy Appears to Prevent Increased AVD Risk in ITP

Data showed a significantly lower rate of AVD in patients with ITP who received a splenectomy during 2007, 2009, and 2010, with a comparable numerical—though not statistically significant—trend in the other years. In 2007 specifically, patients with splenectomy had a rate of AVD of 0.6% compared with 2.0% in patients without (odds ratio [OR], 0.29; 95% CI, 0.09-0.91; P=.02). Likewise, respective rates in 2010 were 0.2% versus 1.9% (OR, 0.13; 95% CI, 0.02-0.92; P=.02).

Finally, analyses adjusted for age, gender, race, diabetes, hypertension, hyperlipidemia, and tobacco use verified that patients with ITP who underwent splenectomy were not associated with increased risk for AVD in 2005 (OR, 0.48; 95% CI, 0.18-1.30; P=.15) or 2014 (OR, 0.88; 95% CI, 0.36-2.16; P=.77).

“Based on a large inpatient database,” Haseefa concluded, “our previous finding of ITP patients’ association with AVD is only present in patients without splenectomy, and splenectomy appears to exert a protective effect on developing aortic valve disease in ITP patients, warranting further investigation.”

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