The recent large decrease in
splenectomy use for chronic
immune thrombocytopenia (
ITP) is partly due to still-unsolved questions about long-term safety. We performed the first single-center exposed/unexposed cohort study evaluating the long-term incidence of
splenectomy complications in patients with primary
ITP. Overall, 83 patients who underwent
splenectomy more than 10 years ago (exposed) were matched with 83 nonsplenectomized patients (unexposed) on the date of
ITP diagnosis ±5 years, age and gender. After a median follow-up of 192 months (range 0.5-528), 43 patients (52%) achieved overall response after
splenectomy. Splenectomized patients experienced more
venous thromboembolism (VTE) than controls (n = 13 vs n = 2, P = 0.005). On multivariate analysis,
splenectomy was an independent risk factor of VTE (hazard ratio = 4.006, P = 0.032 [95% confidence interval: 1.13-14.21]). Splenectomized patients presented more severe
infections on long-term follow-up: all required hospitalization, and 5/26 (19%)
infections led to
severe sepsis or
septic shock and to death for 3 cases (none in controls). However, the incidence of
malignancy was similar in both groups, as was cardiovascular risk, which appeared to be related more to
ITP than
splenectomy. Finally,
splenectomy did not significantly decrease overall survival. Despite the risk of
thrombosis and
severe sepsis,
splenectomy remains an effective and curative treatment for
ITP.