Spontaneous Splenic Hemorrhage Research Articles

A Spleen Complication After an Acute Myocardial Infarction

We highlight the potential risk of combined antithrombotic therapy as a rare cause of spontaneous splenic hemorrhage. Conservative management is possible and reintroduction of the antithrombotic therapy is safe after the acute event. (Level of Difficulty: Beginner.)

Spontaneous splenic hemorrhage after initiation of dabigatran (Pradaxa) for atrial fibrillation

Dabigatran etexilate (Pradaxa; Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT) is an oral anticoagulant that produces a reliable, dose-dependent anticoagulant effect without the need for routine laboratory monitoring. Dabigatran is a direct thrombin inhibitor, acting like other members in its class (bivalirudin, argatroban) to impede the clotting process through selective and reversible binding with both free and clot-bound thrombin. Dabigatran anticoagulates rapidly: plasma levels peak 2 hours after absorption, with a half-life that ranges between 12 and 17 hours. Dabigatran was approved by the Food and Drug Administration in October 2010 after it compared favorably with warfarin in a large clinical trial studying its efficacy in stroke prevention in atrial fibrillation. Currently, there is no laboratory test on the market by which a physician can quantify the anticoagulation effect of dabigatran, nor is there any antidote to reverse a life-threatening bleed should it occur. We present a case of a patient with splenic hemorrhagic soon after initiation of dabigatran.

Splenorrhaphy in infectious mononucleosis

Prior reports suggest that in infectious mononucleosis spontaneous splenic hemorrhage requires removal rather than preservation since the inflamed spleen is too soft and fragile to be safely retained. We describe a 17-year-old girl who had successful splenorrhaphy following complete rupture. Blood loss was 3 l. Salvage succeeded because of both pursestring absorbable mesh repair and argon beam coagulation. Her spleen, which was five times normal size, soft, friable, and of poor integrity, is now viable, normal in size, and perfused adequately. This case may be the first on record.