From the Guidelines
The diagnosis of splenic infarction significantly increases suspicion for an underlying hypercoagulable state due to the spleen's rich blood supply, making spontaneous clot formation uncommon without an underlying predisposition to thrombosis. The spleen's unique vascular structure, with its low-pressure and low-flow system, is not typically prone to thrombosis without an underlying coagulation disorder 1. Hypercoagulable states, such as antiphospholipid syndrome, protein C or S deficiency, factor V Leiden mutation, malignancy, or polycythemia vera, can increase the risk of inappropriate blood clot formation throughout the body, including the splenic vessels 1.
Key Points to Consider
- Splenic infarction typically results from arterial or venous occlusion, cutting off blood supply to a portion of the spleen and causing tissue death.
- In the absence of other clear causes like emboli from cardiac sources, trauma, sickle cell disease, or vasculitis, the presence of splenic infarction should prompt a thorough hypercoagulability workup.
- This evaluation typically includes tests for inherited and acquired thromophilias, such as antiphospholipid antibodies, factor V Leiden, prothrombin gene mutation, and protein C, S, and antithrombin III levels.
- Early identification of an underlying hypercoagulable state is crucial as it may require specific management strategies, including long-term anticoagulation, to prevent further thrombotic events in other organs, as supported by recent guidelines on anticoagulation for splenic vein thrombosis 1.
Management and Prevention
- Anticoagulation appears to lower the risk for recurrent thrombosis in patients with splenic vein thrombosis without increasing the risk for severe bleeding, including in patients with underlying prothrombotic states 1.
- An individual-patient meta-analysis of the effectiveness and safety of anticoagulation for splenic vein thrombosis further supports the use of anticoagulation in these patients 1.
- The decision to initiate anticoagulation should be made on a case-by-case basis, considering the patient's underlying risk factors, the presence of any contraindications to anticoagulation, and the potential benefits of preventing further thrombotic events.
From the Research
Diagnosis of Splenic Infarction and Hypercoagulable State
The diagnosis of splenic infarction increases suspicion for an underlying hypercoagulable state due to several factors:
- Splenic infarction is often associated with a prothrombotic state, making patients vulnerable to subsequent thromboembolic complications 2
- The condition can be caused by various underlying mechanisms, including cardioembolic, vascular, and haematologic disorders 3
- Atrial fibrillation, a common cause of splenic infarction, is a well-known risk factor for thromboembolic events 4, 5
- Other conditions, such as infectious endocarditis, can also lead to splenic infarction through septic embolization 6
- The presence of splenic infarction may indicate an underlying coagulation disorder, which can increase the risk of further thromboembolic complications
Underlying Causes of Splenic Infarction
Some of the underlying causes of splenic infarction that may contribute to a hypercoagulable state include:
- Cardioembolic events, such as atrial fibrillation 3, 4, 5
- Haematologic disorders, such as antiphospholipid syndrome 3
- Vascular disorders, such as atherosclerosis 3
- Infectious endocarditis, which can lead to septic embolization 6
- Other conditions, such as non-obstructive hypertrophic cardiomyopathy 5
Diagnostic Approach
A diagnostic approach to splenic infarction should include:
- Imaging studies, such as abdominal CT scan, ultrasonography, and arteriography 3, 4, 5, 6
- Laboratory tests, such as complete blood count, liver function tests, and coagulation studies 3, 4, 5
- Echocardiography to evaluate cardiac function and rule out cardioembolic sources 3, 4, 5
- Blood cultures to rule out infectious causes 3, 6