Table 1.

Recommended strategies to prevent early and late complications after splenectomy

Complication	Early	Late
Surgical morbidity	Careful patient selection: older patients and those with comorbidities are less attractive candidates for surgery and anesthesia. Alternative therapies should be considered.
Bleeding	Laparoscopic splenectomy
	Elevation of platelets to >30 × 109/L to 50 × 109/L using steroids, IVIg (or TPO-RA if no response to these)
Infection	Vaccination against S pneumoniae, H influenzae type b, and N meningitidis, ideally at least 2 wk prior to surgery	Repeat vaccination against S pneumoniae every 5 y, annual influenza vaccine
	Education about the risk of postsplenectomy sepsis. Emphasize need for early administration of antibiotics in case of fever.	Patients may be at higher risk of babesiosis and malaria and should be aware of this if traveling to endemic areas.
	Consider prophylactic antibiotics postoperatively.
Vascular complications	Early mobilization, hydration, and initiation of prophylactic anticoagulation once hemostasis has been ensured in patients with other risk factors for thrombosis	Address modifiable risk factors (smoking, obesity, etc.).
Early		Aspirin may be prescribed for patients with cardiovascular risk factors.
Postoperative VTE including acute portal/splenic vein thrombosis		Thromboprophylaxis in the setting of elective surgery or other situations that increase thrombotic risk
Late
VTE
Atherothrombotic events