CO048 | PREDICTORS OF FIRST THROMBOTIC EVENTS AFTER MECHANICAL VALVE REPLACEMENT FOR RHEUMATIC HEART DISEASE: A RETROSPECTIVE COHORT STUDY FROM SALAM CENTER FOR CARDIAC SURGERY (SUDAN)
Abstract
Background and aims. Rheumatic heart disease (RHD) is endemic in sub-Saharan Africa. In advanced disease, valve replacement is a therapeutic option. In young patients, mechanical valves are often preferred because of their durability. However, they require lifelong anticoagulation with vitamin K antagonists (VKAs), with dose adjustment based on close laboratory monitoring to prevent prosthetic valve thrombosis (PVT) and thromboembolism. The aim of the study is the identification of perioperative and early follow-up predictors of the first thrombotic event after valve replacement in patients with RHD. Methods. In this retrospective cohort study, we included all consecutive patients who underwent mechanical valve replacement surgery from 1 July 2018 to 31 December 2021. All patients were followed at the Salam Centre Anticoagulation Clinic. The observation period ended on 28 February 2023. Collected variables included sex, age at surgery, country/region of origin, NYHA class and cardiac rhythm at admission, BMI, comorbidities (hypertension and diabetes), preoperative white blood cell count, hemoglobin, platelet count, and eosinophil count, type and brand/model of implanted valve, left ventricular ejection fraction at discharge, discharge medical therapy, and time in therapeutic range (TTR) during the first 6 months after warfarin initiation. The primary outcome was the first objectively documented thrombotic event after surgery. Results. A total of 41 first thrombotic events were recorded during follow-up. All events were arterial, 31 PVT, and 10 ischemic strokes. Compared with patients who did not develop thrombosis (n=712), those who developed thrombosis (n=41) did not differ significantly in sex, age at surgery, country or region of origin, type of surgery, comorbidities, NYHA class, cardiac rhythm at admission, left ventricular ejection fraction at discharge, discharge medical therapy, or mean TTR during the first 6 months after warfarin initiation. Among patients undergoing mitral valve replacement, valve type distribution differed significantly between groups (p=0.045), with a higher proportion of Carbomedics valves in the thrombosis group. Patients who developed thrombosis also had higher preoperative white blood cell counts (7.6 [6.5–9.4] vs 6.6 [5.2–8.4], p=0.01) and higher eosinophil counts (260 [130–580] vs 130 [50–260], p<0.01). Consistently, eosinophilia was more frequent in the thrombosis group at all thresholds examined: ≥350/µL (39.0% vs 17.3%, p=0.001), ≥500/µL (29.3% vs 11.4%, p=0.002), and ≥1500/µL (7.3% vs 0.8%, p=0.01). In the multivariable Cox proportional hazards model, higher preoperative eosinophil count was independently associated with an increased risk of a first thrombotic event: each increase of 100 cells/µL was associated with a 13% higher hazard (HR 1.13, 95% CI 1.09–1.18; p<0.001). NYHA class IV at admission was also associated with a higher hazard compared with NYHA class I (HR 3.87, 95% CI 1.05–14.29; p=0.042). Conclusions. Higher preoperative eosinophil count was consistently associated with subsequent thrombotic events after mechanical valve replacement. This finding suggests that eosinophilia may identify a subgroup of patients with a pro-thrombotic or pro-inflammatory profile who may require closer peri-operative assessment and follow-up. The underlying causes of eosinophilia warrant further investigation, including evaluation for parasitic infection where clinically appropriate.
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BibTeX
@article{erba2026co048,
title = {{CO048 | PREDICTORS OF FIRST THROMBOTIC EVENTS AFTER MECHANICAL VALVE REPLACEMENT FOR RHEUMATIC HEART DISEASE: A RETROSPECTIVE COHORT STUDY FROM SALAM CENTER FOR CARDIAC SURGERY (SUDAN)}},
author = {Nicoletta Erba},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/750},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - CO048 | PREDICTORS OF FIRST THROMBOTIC EVENTS AFTER MECHANICAL VALVE REPLACEMENT FOR RHEUMATIC HEART DISEASE: A RETROSPECTIVE COHORT STUDY FROM SALAM CENTER FOR CARDIAC SURGERY (SUDAN)
AU - Nicoletta Erba
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/750
AB - Background and aims. Rheumatic heart disease (RHD) is endemic in sub-Saharan Africa. In advanced disease, valve replacement is a therapeutic option. In young patients, mechanical valves are often preferred because of their durability. However, they require lifelong anticoagulation with vitamin K antagonists (VKAs), with dose adjustment based on close laboratory monitoring to prevent prosthetic valve thrombosis (PVT) and thromboembolism. The aim of the study is the identification of perioperative and early follow-up predictors of the first thrombotic event after valve replacement in patients with RHD. Methods. In this retrospective cohort study, we included all consecutive patients who underwent mechanical valve replacement surgery from 1 July 2018 to 31 December 2021. All patients were followed at the Salam Centre Anticoagulation Clinic. The observation period ended on 28 February 2023. Collected variables included sex, age at surgery, country/region of origin, NYHA class and cardiac rhythm at admission, BMI, comorbidities (hypertension and diabetes), preoperative white blood cell count, hemoglobin, platelet count, and eosinophil count, type and brand/model of implanted valve, left ventricular ejection fraction at discharge, discharge medical therapy, and time in therapeutic range (TTR) during the first 6 months after warfarin initiation. The primary outcome was the first objectively documented thrombotic event after surgery. Results. A total of 41 first thrombotic events were recorded during follow-up. All events were arterial, 31 PVT, and 10 ischemic strokes. Compared with patients who did not develop thrombosis (n=712), those who developed thrombosis (n=41) did not differ significantly in sex, age at surgery, country or region of origin, type of surgery, comorbidities, NYHA class, cardiac rhythm at admission, left ventricular ejection fraction at discharge, discharge medical therapy, or mean TTR during the first 6 months after warfarin initiation. Among patients undergoing mitral valve replacement, valve type distribution differed significantly between groups (p=0.045), with a higher proportion of Carbomedics valves in the thrombosis group. Patients who developed thrombosis also had higher preoperative white blood cell counts (7.6 [6.5–9.4] vs 6.6 [5.2–8.4], p=0.01) and higher eosinophil counts (260 [130–580] vs 130 [50–260], p<0.01). Consistently, eosinophilia was more frequent in the thrombosis group at all thresholds examined: ≥350/µL (39.0% vs 17.3%, p=0.001), ≥500/µL (29.3% vs 11.4%, p=0.002), and ≥1500/µL (7.3% vs 0.8%, p=0.01). In the multivariable Cox proportional hazards model, higher preoperative eosinophil count was independently associated with an increased risk of a first thrombotic event: each increase of 100 cells/µL was associated with a 13% higher hazard (HR 1.13, 95% CI 1.09–1.18; p<0.001). NYHA class IV at admission was also associated with a higher hazard compared with NYHA class I (HR 3.87, 95% CI 1.05–14.29; p=0.042). Conclusions. Higher preoperative eosinophil count was consistently associated with subsequent thrombotic events after mechanical valve replacement. This finding suggests that eosinophilia may identify a subgroup of patients with a pro-thrombotic or pro-inflammatory profile who may require closer peri-operative assessment and follow-up. The underlying causes of eosinophilia warrant further investigation, including evaluation for parasitic infection where clinically appropriate.
SN - 2785-5309
ER -