From the Guidelines
Treatment for splenic infarcts should focus on managing symptoms, addressing the underlying cause, and considering surgical intervention for complications, with a recent study suggesting that splenectomy with appropriate antibiotics is the definitive treatment for splenic abscess, a potential complication of splenic infarct 1. When managing splenic infarcts, it is essential to identify and treat the underlying cause, which may include conditions such as infective endocarditis, requiring appropriate antibiotics, or atrial fibrillation, necessitating anticoagulation therapy.
- For uncomplicated splenic infarcts, conservative management with pain control using NSAIDs or acetaminophen, along with rest and hydration, is often sufficient.
- Anticoagulation therapy may be indicated if the infarct is due to thromboembolism, typically with heparin initially, followed by warfarin or a DOAC for 3-6 months.
- Surgical intervention, such as splenectomy, may be necessary for complications like abscess formation, as suggested by a study published in Circulation 1, which reported that splenectomy with appropriate antibiotics is the definitive treatment for splenic abscess.
- Patients should be monitored with follow-up imaging (ultrasound or CT) to ensure resolution, and the prognosis generally depends on the underlying cause rather than the infarct itself. In cases where splenic abscess is suspected, abdominal CT and MRI appear to be the best tests for diagnosis, with both sensitivities and specificities ranging from 90% to 95% 1.
- Differentiation of splenic abscess from bland infarction may be difficult, but ongoing sepsis, recurrent positive blood cultures, and persistence or enlargement of splenic defects on CT or MRI suggest splenic abscess, which responds poorly to antibiotic therapy alone 1.
From the Research
Treatment Options for Splenic Infarct
- Symptomatic treatment is a common approach for managing splenic infarct, as seen in a case where a patient was monitored and discharged without the need for operation 2.
- Anticoagulant therapy has been associated with decreased long-term mortality in splenic infarction patients, with a multicenter study showing a 94% improved survival rate 3.
- Splenectomy is also considered a treatment option, although it may not always be necessary, as evidenced by a study where patients with high-grade splenic injuries received chemoprophylaxis without an increased risk of nonoperative management failure 4.
Anticoagulant Therapy
- Anticoagulant therapy has been shown to be effective in reducing the risk of thromboembolic complications in patients with splenic infarction 3.
- However, the use of anticoagulation after initial splenic infarct was associated with a nonsignificant increase in recurrent splenic infarct in cancer patients 5.
- The decision to use anticoagulant therapy should be guided by other thromboembolic risk factors, such as prior stroke or liver cirrhosis 3.
Risk Factors and Prognostic Factors
- Atrial fibrillation, hematologic disease, and infective endocarditis are common predisposing conditions associated with splenic infarction 6.
- Tachycardia, positive qSOFA score, history of hypertension, leukocytosis, and thrombocytopenia are also risk factors for splenic infarction 6.
- Lower platelet counts and atrial fibrillation/flutter have been associated with a higher risk of recurrent splenic infarct in cancer patients 5.