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A new scoring system to determine thromboembolic risk after heart valve replacement

Butchart, Eric G., Ionescu, Adrian, Payne, Nicola, Giddings, John, Grunkemeier, Gary L. and Fraser, Alan Gordon 2003. A new scoring system to determine thromboembolic risk after heart valve replacement. Circulation 108 (10 S1) , pp. 68-74. 10.1161/01.cir.0000087383.62522.1e

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Objective— To determine the most important inflammatory and hematologic predictors of thromboembolism (TE) in patients undergoing valve replacement (VR) to be used in conjunction with clinical risk factors for preoperative risk profiling. Methods and Results— Preoperative and immediately postoperative clinical, echocardiographic, hematologic, biochemical and microbiological parameters were examined prospectively in 370 patients undergoing VR (249 AVR, 93 MVR, 28 DVR). Mean follow-up was 4.4 years (max 6.6 years; total 1566 pt/yrs), and 96 TE events were documented (28 major and 68 minor). INR data were collected on all patients. Laboratory values were considered elevated if they exceeded the 80th percentile of those of 70 controls with the same distribution of age and gender. IgA antibody to Chlamydia pneumoniae (CP)≥1:64 was considered indicative of significant infection. Predictors of TE on multivariate analysis following AVR were (hazard ratios): CP infection (2.6), previous TE (2.5), raised eosinophils (2.4), cancer history (2.1), postoperative infection (2.0), hypertension (2.0), CABG × 3/4 (2.0), and diabetes (1.9). Predictors of TE following MVR/DVR were raised mean platelet volume (4.0), raised factor VII (3.1), CP infection (2.7), previous mitral valvotomy (2.5), raised fibrinogen (2.2), and raised reticulocytes (2.0). These risk factors were additive when present in the same patient, enabling a scoring system to be developed that accurately predicted risk of TE based on number of risk factors. Conclusions— Selected blood tests and clinical risk factors provide a scoring system that accurately predicts TE risk and may guide prosthesis choice and antithrombotic management.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: heart valve prosthesis; embolism; risk factors
Additional Information: Pdf uploaded in accordance with publisher's policy at (accessed 19/02/2014).
Publisher: American Heart Association
ISSN: 0009-7322
Date of First Compliant Deposit: 30 March 2016
Last Modified: 04 Jun 2017 04:59

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