{"doi":"10.1002/ajh.27714","title":"Thromboembolic Events Are Increased After Splenectomy in Postmenopausal Women","abstract":"In the United States, 22 000 splenectomies are performed annually [1] for various conditions. Splenectomy has been linked to overwhelming sepsis and more recently to thromboembolic events (TEE) [2-5]. Danish national registry studies documented the increased occurrence of TEE postsplenectomy; however, earlier studies were restricted to males and later ones, including two Danish studies, did not discriminate TEE in women from those in men [2-4]. TEE risk differs between men and women in several ways [5], so sex-specific assessments are critical. Premenopausal women have a predisposition to TEE for several reasons including hormonal and autoimmune ones; however, TEE risk remains unclear in postmenopausal women. We therefore conducted a prospective cohort study within the Nurses' Health Study (NHS) using biennial questionnaires with medical record confirmation of thromboses to robustly assess association between splenectomy and TEE in postmenopausal women. The NHS was established in 1976 and enrolled 121 700 female registered nurses between 30 and 55 years old. Splenectomy history was included on the 2004 questionnaire and 90 853 postmenopausal women (at that time between ages of 58 and 83 years) were included in the current analysis. The biennial questionnaires asked participants whether they had stroke, myocardial infarction (MI), deep vein thrombosis (DVT), or pulmonary emboli (PE) since cohort inception. Participants self-reporting TEE received letters requesting confirmatory medical records. Through 2012, questions about DVT and PE were distinct; subsequently, 2012–2016, participants were asked about both as a single outcome. The primary outcomes included DVT, PE, stroke and MI, self-reported on biennial questionnaires. Follow-up for this nested cohort study started in 2004 after all splenectomies. End of follow-up was through the 2016 questionnaire, date of death, or diagnosis of outcome, whichever came first. Loss to follow-up in NHS is < 5% every 2-year cycle. Date and cause of death were obtained through linkage with the National Death Index. We conducted a prospective analyses (start from 2004) with Cox Proportional Hazard models to generate hazard ratios and 95% confidence intervals (CIs). We included the following covariates as potential confounders in multivariate models: (a) continuous variables: age, BMI, hypertension, and cholesterol level; and (b) yes/no variables: smoking status, physical activity, diabetes, and menopausal hormone therapy. Biennial questionnaires did not include a specific question about reason for splenectomy. Participants had the option to report these diagnoses under “other illnesses.” They were then mapped to ICD-9 and ICD-10 disease codes including categorizing these conditions into definite ITP (codes = 287.31), and possible ITP (codes = 287.30). Thirty-four participants were considered “ITP,” too few to perform a sub-analysis. The reason for most splenectomies was unknown. In 2004, 323 participants in NHS reported having had a splenectomy, among the 90 853 participants completing that year's questionnaire. The mean age of study participants was similar for those reporting splenectomy (64.5 years) and those without splenectomy (63.6 years) (Table 1A). Participants reporting a splenectomy were similar to women who never underwent splenectomy on height, BMI, race, comorbidities (e.g., diabetes, high blood pressure, elevated cholesterol) and covariates (e.g., aspirin, smoking status, past physical activity) (Table 1A). Participants were all female and overwhelmingly white consistent with demographics of those entering nursing in 1976. Seventy-five percent of participants who underwent splenectomy did so in 1996 or before, 14% in 1997–2001, 2% in 2002, 3% in 2003, and 2% in 2004. In age-adjusted models (Table 1B), women who had undergone splenectomy had a greater than threefold risk of DVT compared to women who had not (hazard ratio 3.16 [95% CI: 1.50–6.66]). In the fully multivariate model, t","journal":"American Journal of Hematology","year":2025,"id":544877,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":218471,"name":"Yi Mu","orcid":"0000-0001-5660-440X","position":1,"is_corresponding":false},{"id":178434,"name":"Christopher Kabrhel","orcid":"0000-0002-8699-7176","position":2,"is_corresponding":false},{"id":246330,"name":"Bernard Rosner","orcid":"0000-0001-6907-0056","position":3,"is_corresponding":false},{"id":321496,"name":"Rulla M. Tamimi","orcid":"0000-0003-2306-8668","position":4,"is_corresponding":false},{"id":602146,"name":"James B. Bussel","orcid":"0000-0002-2884-9247","position":5,"is_corresponding":false},{"id":867543,"name":"Qi Feng","orcid":"0000-0001-6810-7363","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T02:53:17.418915Z","pmid":"40539548","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}