Construction and validation of a model for predicting the risk of post-thrombotic syndrome in patients with acute lower extremity deep venous thrombosis after interventional therapy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TIAN Zhong ¹ , TIAN Zhilong ¹ , SUN Pengcheng ¹ , QIN Ruihao ¹ , YUAN Lei ² , ZHANG Hui ² , WANG Jianyu ² ,  YUAN Fukang ¹

1. Department of Vascular Surgery, the Affiliated Xuzhou Clinical College of Xuzhou Medical University/Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P. R. China;
2. Department of Intervention, Xuzhou Cancer Hospital, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

YUAN Fukang, Email: jsbuck520@163.com

Keywords：

acute lower extremity deep venous thrombosis; post-thrombotic syndrome; prediction model; validation; interventional therapy

DOI：

10.7507/1007-9424.202410115

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective The purpose of this study was to establish and validate a risk prediction model for post-thrombotic syndrome (PTS) in patients after interventional treatment for acute lower extremity deep vein thrombosis (LEDVT). Methods A retrospective study was conducted to collect data from 234 patients with acute LEDVT who underwent interventional treatment at Xuzhou Central Hospital between December 2017 and June 2022, serving as the modeling set. Factors influencing the occurrence of PTS were analyzed, and a nomogram was developed. An additional 98 patients from the same period treated at Xuzhou Tumor Hospital were included as an external validation set to assess the reliability of the model. Results Among the patients used to establish the model, the incidence of PTS was 25.2% (59/234), while in the validation set was 31.6% (31/98). Multivariate logistic regression analysis of the modeling set identified the following factors as influencing PTS: age (OR=1.076, P=0.001), BMI (OR=1.163, P=0.004), iliac vein stent placement (OR=0.165, P<0.001), history of varicose veins (OR=5.809, P<0.001), and preoperative D-dimer level (OR=1.341, P<0.001). These 5 factors were used to construct the risk prediction model. The area under the ROC curve (AUC) of the model was 0.869 [95%CI (0.819, 0.919)], with the highest Youden index of 0.568, corresponding to a sensitivity of 79.7% and specificity of 77.1%. When applied to the validation set, the AUC was 0.821 [95%CI (0.734, 0.909)], with sensitivity of 77.4%, specificity of 76.1%, and accuracy of 76.6%. Conclusions The risk prediction model for PTS established in this study demonstrates good predictive performance. The included parameters are simple and practical, providing a useful reference for clinicians in the preliminary screening of high-risk PTS patients.

1.	Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 2014, 130(18): 1636-1661.
2.	Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest, 2021, 160(6): e545-e608.
3.	中国微循环学会周围血管疾病专业委员会下肢静脉腔内治疗专业委员会. 急性下肢深静脉血栓形成腔内治疗专家共识. 血管与腔内血管外科杂志, 2023, 9(5): 513-519.
4.	Kahn SR, Partsch H, Vedantham S, et al. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost, 2009, 7(5): 879-883.
5.	Amin EE, van Kuijk SMJ, Joore MA, et al. Development and validation of a practical two-step prediction model and clinical risk score for post-thrombotic syndrome. Thromb Haemost, 2018, 118(7): 1242-1249.
6.	孙亚峰, 仇鹏, 黄家麒. 急性髂股静脉血栓形成患者下肢深静脉血栓形成后综合征的影响因素分析. 中华解剖与临床杂志, 2022, 27(2): 110-114.
7.	黄天安, 金泳海, 梁黎, 等. 下肢深静脉血栓形成后综合征风险列线图预测模型建立. 介入放射学杂志, 2022, 31(1): 35-38.
8.	Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med, 1996, 125(1): 1-7.
9.	Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2016, 2016(1): 413-418.
10.	Makedonov I, Kahn SR, Galanaud JP. Prevention and management of the post-thrombotic syndrome. J Clin Med, 2020, 9(4): 923.
11.	Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
12.	Streiff MB, Milentijevic D, McCrae K, et al. Effectiveness and safety of anticoagulants for the treatment of venous thromboembolism in patients with cancer. Am J Hematol, 2018, 93(5): 664-671.
13.	Gregson J, Kaptoge S, Bolton T, et al. Cardiovascular risk factors associated with venous thromboembolism. JAMA Cardiol, 2019, 4(2): 163-173.
14.	Rinfret F, Gu CS, Vedantham S, et al. New and known predictors of the postthrombotic syndrome: a subanalysis of the ATTRACT trial. Res Pract Thromb Haemost, 2022, 6(6): e12796.
15.	Zhang J, Ma F, Yao J, et al. Development and validation of a clinical prediction model for post thrombotic syndrome following anticoagulant therapy for acute deep venous thrombosis. Thromb Res, 2022, 214: 68-75.
16.	张蕴鑫, 陈小丫, 汤迎磊, 等. 深静脉血栓后综合征的病理生理学改变和系统性防治理念. 血管与腔内血管外科杂志, 2022, 8(12): 1477-1482.
17.	章杰, 张喜成. 血栓性髂静脉狭窄的诊疗现状与趋势. 中国普外基础与临床杂志, 2019, 26(3): 369-373.
18.	Taha MAH, Busuttil A, Bootun R, et al. A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 258-266.
19.	Jayaraj A, Fuller R, Raju S, et al. In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 42-51.
20.	Guo X, Xu H, Zhang J, et al. A systematic review and meta-analysis of risk prediction models for post-thrombotic syndrome in patients with deep vein thrombosis. Heliyon, 2023, 9(11): e22226.
21.	Constantinescu AE, Bull CJ, Goudswaard LJ, et al. A phenome-wide approach to identify causal risk factors for deep vein thrombosis. BMC Med Genomics, 2023, 16(1): 284.
22.	Yang X, Zhang X, Yin M, et al. Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal. J Vasc Surg Venous Lymphat Disord, 2022, 10(2): 293-299.
23.	曾彦彰, 袁平, 何强. 导管接触溶栓与单纯抗凝治疗急性近端深静脉血栓形成的疗效对比研究. 中国普外基础与临床杂志, 2024, 31(3): 315-319.
24.	Bittar LF, Silva LQD, Orsi FLA, et al. Increased inflammation and endothelial markers in patients with late severe post-thrombotic syndrome. PLoS One, 2020, 15(1): e0227150.
25.	Iding AFJ, Pallares Robles A, Ten Cate V, et al. Exploring phenotypes of deep vein thrombosis in relation to clinical outcomes beyond recurrence. J Thromb Haemost, 2023, 21(5): 1238-1247.
26.	Yu T, Song J, Yu L, et al. A systematic evaluation and meta-analysis of early prediction of post-thrombotic syndrome. Front Cardiovasc Med, 2023, 10: 1250480.
27.	Karathanos C, Nana P, Spanos K, et al. Efficacy of rivaroxaban in prevention of post-thrombotic syndrome: a systematic review and meta-analysis. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1568-1576.

1. Kahn SR, Comerota AJ, Cushman M, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation, 2014, 130(18): 1636-1661.
2. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest, 2021, 160(6): e545-e608.
3. 中国微循环学会周围血管疾病专业委员会下肢静脉腔内治疗专业委员会. 急性下肢深静脉血栓形成腔内治疗专家共识. 血管与腔内血管外科杂志, 2023, 9(5): 513-519.
4. Kahn SR, Partsch H, Vedantham S, et al. Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost, 2009, 7(5): 879-883.
5. Amin EE, van Kuijk SMJ, Joore MA, et al. Development and validation of a practical two-step prediction model and clinical risk score for post-thrombotic syndrome. Thromb Haemost, 2018, 118(7): 1242-1249.
6. 孙亚峰, 仇鹏, 黄家麒. 急性髂股静脉血栓形成患者下肢深静脉血栓形成后综合征的影响因素分析. 中华解剖与临床杂志, 2022, 27(2): 110-114.
7. 黄天安, 金泳海, 梁黎, 等. 下肢深静脉血栓形成后综合征风险列线图预测模型建立. 介入放射学杂志, 2022, 31(1): 35-38.
8. Prandoni P, Lensing AW, Cogo A, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med, 1996, 125(1): 1-7.
9. Kahn SR. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program, 2016, 2016(1): 413-418.
10. Makedonov I, Kahn SR, Galanaud JP. Prevention and management of the post-thrombotic syndrome. J Clin Med, 2020, 9(4): 923.
11. Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med, 2008, 149(10): 698-707.
12. Streiff MB, Milentijevic D, McCrae K, et al. Effectiveness and safety of anticoagulants for the treatment of venous thromboembolism in patients with cancer. Am J Hematol, 2018, 93(5): 664-671.
13. Gregson J, Kaptoge S, Bolton T, et al. Cardiovascular risk factors associated with venous thromboembolism. JAMA Cardiol, 2019, 4(2): 163-173.
14. Rinfret F, Gu CS, Vedantham S, et al. New and known predictors of the postthrombotic syndrome: a subanalysis of the ATTRACT trial. Res Pract Thromb Haemost, 2022, 6(6): e12796.
15. Zhang J, Ma F, Yao J, et al. Development and validation of a clinical prediction model for post thrombotic syndrome following anticoagulant therapy for acute deep venous thrombosis. Thromb Res, 2022, 214: 68-75.
16. 张蕴鑫, 陈小丫, 汤迎磊, 等. 深静脉血栓后综合征的病理生理学改变和系统性防治理念. 血管与腔内血管外科杂志, 2022, 8(12): 1477-1482.
17. 章杰, 张喜成. 血栓性髂静脉狭窄的诊疗现状与趋势. 中国普外基础与临床杂志, 2019, 26(3): 369-373.
18. Taha MAH, Busuttil A, Bootun R, et al. A clinical guide to deep venous stenting for chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 258-266.
19. Jayaraj A, Fuller R, Raju S, et al. In-stent restenosis and stent compression following stenting for chronic iliofemoral venous obstruction. J Vasc Surg Venous Lymphat Disord, 2022, 10(1): 42-51.
20. Guo X, Xu H, Zhang J, et al. A systematic review and meta-analysis of risk prediction models for post-thrombotic syndrome in patients with deep vein thrombosis. Heliyon, 2023, 9(11): e22226.
21. Constantinescu AE, Bull CJ, Goudswaard LJ, et al. A phenome-wide approach to identify causal risk factors for deep vein thrombosis. BMC Med Genomics, 2023, 16(1): 284.
22. Yang X, Zhang X, Yin M, et al. Elastic compression stockings to prevent post-thrombotic syndrome in proximal deep venous thrombosis patients without thrombus removal. J Vasc Surg Venous Lymphat Disord, 2022, 10(2): 293-299.
23. 曾彦彰, 袁平, 何强. 导管接触溶栓与单纯抗凝治疗急性近端深静脉血栓形成的疗效对比研究. 中国普外基础与临床杂志, 2024, 31(3): 315-319.
24. Bittar LF, Silva LQD, Orsi FLA, et al. Increased inflammation and endothelial markers in patients with late severe post-thrombotic syndrome. PLoS One, 2020, 15(1): e0227150.
25. Iding AFJ, Pallares Robles A, Ten Cate V, et al. Exploring phenotypes of deep vein thrombosis in relation to clinical outcomes beyond recurrence. J Thromb Haemost, 2023, 21(5): 1238-1247.
26. Yu T, Song J, Yu L, et al. A systematic evaluation and meta-analysis of early prediction of post-thrombotic syndrome. Front Cardiovasc Med, 2023, 10: 1250480.
27. Karathanos C, Nana P, Spanos K, et al. Efficacy of rivaroxaban in prevention of post-thrombotic syndrome: a systematic review and meta-analysis. J Vasc Surg Venous Lymphat Disord, 2021, 9(6): 1568-1576.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesConstruction and validation of a model for predicting the risk of post-thrombotic syndrome in patients with acute lower extremity deep venous thrombosis after interventional therapy

Abstract Full text Figures/Tables Video References Cited by

Format

Content