Risk factors of lower extremity deep vein thrombosis after cardiac valve replacement for rheumatic heart disease:an analysis based on propensity score matching
Gao Yuan
Wang Junsheng
Yang Shuqiang
Abstract：Objective To analyzed the risk factors of lower extremity deep vein thrombosis (DVT) after cardiac valve replacement for rheumatic heart disease (RHD) based on balance confounding factors of propensity score matching (PSM).Methods The clinical materials were retrospectively analyzed in RHD patients (n=389) undergone cardiac valve replacement in Department of Cardiac-Vascular Surgery of People's Hospital of Anyang City from Jan.2018 to Jan.2023.The patients were divided,according to whether they complicated by lower extremity DVT or not within 1 week after the operation,into DVT group (n=35) and non-DVT group (n=354).The baseline materials were matching in a 1︰2 ratio by using PMS,including gender,age,body mass index (BMI),history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NAHY heart function classification and basic disease history.The baseline materials were compared between 2 groups before and after matching.After matching,the risk factors of lower extremity DVT were analyzed by using multi-factor Logistic regression analysis in RHD patients after cardiac valve replacement.Results Before matching,the differences in gender,age,BMI,RHD course,valve material and history of diabetes,hyperlipidemia and atrial fibrillation (AF) had statistical significance (P＜0.05),and the differences in history of smoking and drinking,lesion type,replacement location,NYHA heart function classification and hypertension history had no statistical significance (P＞0.05) between 2 groups.After PSM,there were 32 RHD patients in DVT group and 64 RHD patients in non-DVT group.The differences in gender,age,BMI,history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NYHA heart function classification and basic disease history had no statistical significance (P＞0.05) between 2 groups.After matching,preoperative platelet count (PLT),level of plasma D-dimer (D-D),proportion of abnormal 4 items of coagulation tests,level of triglyceride (TG),operation duration,international normalized ratio (INR) on the right postoperative day,warfarin dose and postoperative bed rest days were higher in DVT group than those in non-DVT group (P＜0.05).The results of multi-factor Logistic regression analysis showed that higher preoperative D-D level,abnormal 4 items of coagulation tests,higher levels of PLT and TG,longer operation duration,higher warfarin dose and longer postoperative bed rest days were risk factors of lower extremity DVT in RHD patients after cardiac valve replacement (P＜0.05).When preoperative D-D＞395.25 ng/ml,PLT＞312.22×109/L and TG＞1.94 mmol/L,AUC was,respectively,0.799,0.777 and 0.813 in RHD patients after cardiac valve replacement.Conclusion After PSM for baseline material balance,preoperative plasma D-D level,abnormal 4 items of coagulation tests,PLT,TG level,operation duration,warfarin dose and postoperative bed rest days are influence factors in RHD patients complicated by lower extremity DVT after cardiac valve replacement.
Keywords：Rheumatic heart diseaseCardiac valve replacementPropensity score matchingRisk factors
Publication Date：2024-12-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 1496-1501 )