Predictive model for deep venous thrombosis caused by closed lower limb fracture after thromboprophylactic treatment

J. Xing, Y.-H. Fu, Z. Song, Q. Wang, T. Ma, M. Li, Y. Zhuang, Z. Li, Y.-J. Zhu, W. Tang, S.-G. Wang, N. Yang, P.-F. Wang, K. Zhang

Department of Orthopedics and Traumatology, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, China. pengfei_wang@163.com

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• Orthopedics
• Pharmacology

OBJECTIVE: Currently, there are still no convincing clinical models predicting closed lower extremity fracture-associated deep vein thrombosis in patients treated through thromboprophylactic methods. We aimed at using two retrospective cohorts to develop and externally verify a clinical prediction model for deep vein thrombosis in patients treated with anticoagulants after suffering closed lower extremity fractures.

PATIENTS AND METHODS: We evaluated the patients’ pre- and post-operatively, to accurately determine the predictive power of the biomarkers and clinical risk factors. Two retrospective cohorts were used for the development and external verification of a pre-operative clinical prediction model (development: n = 2,253; verification: n = 833) and post-operative clinical prediction model (development: n = 1,422; verification: n = 449), respectively.

RESULTS: The C-indices were used to show the predicted incidence of objective thrombosis at the pre- and post-operative stage, which were then compared with the observed incidence of thrombosis in both cohorts. Biomarkers and clinical indicators were included in pre- and post-operative nomograms, which were adequately calibrated in both cohorts. The cross-validated C-indices of the pre- and post-operative clinical prediction models in the verification cohort were 0.706 (95% Cl, 0.67-0.74) and 0.875 (95% Cl, 0.84-0.91), respectively.

CONCLUSIONS: We present our findings of novel pre- and post-operative nomograms for the prediction of deep venous thrombosis in patients who received thromboprophylaxis after suffering closed lower extremity fractures.

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