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. 2024 Apr 17;22(1):37.
doi: 10.1186/s12959-024-00607-6.

Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Mirjana Mitrovic  1   2 , Nikola Pantic  3 , Zoran Bukumiric  4 , Nikica Sabljic  3 , Marijana Virijevic  3   5 , Zlatko Pravdic  3 , Mirjana Cvetkovic  3 , Nikola Ilic  6 , Jovan Rajic  3 , Milena Todorovic-Balint  3   5 , Ana Vidovic  3   5 , Nada Suvajdzic-Vukovic  3   5 , Jecko Thachil  7 , Darko Antic  3   5
Affiliations

Venous thromboembolism in patients with acute myeloid leukemia: development of a predictive model

Mirjana Mitrovic et al. Thromb J. .

Abstract

Background: Patients with acute myeloid leukemia (AML) are at increased risk of venous thromboembolic events (VTE). However, thromboprophylaxis is largely underused.

Objectives: This study aimed to determine possible VTE development risk factors and to develop a novel predictive model.

Methods: We conducted a retrospective cohort study of adult patients with newly diagnosed AML. We used univariate and multivariable logistic regression to estimate binary outcomes and identify potential predictors. Based on our final model, a dynamic nomogram was constructed with the goal of facilitating VTE probability calculation.

Results: Out of 626 eligible patients with AML, 72 (11.5%) developed VTE during 6 months of follow-up. Six parameters were independent predictors: male sex (odds ratio [OR] 1.82, 95% confidence interval [CI]: 1.077-2.065), prior history of thrombotic events (OR 2.27, 95% CI: 1.4-4.96), international normalized ratio (OR 0.21, 95% CI: 0.05-0.95), Eastern Cooperative Oncology Group performance status (OR 0.71, 95% CI: 0.53-0.94), and intensive therapy (OR 2.05, 95% CI: 1.07-3.91). The C statistics for the model was 0.68. The model was adequately calibrated and internally validated. The decision-curve analysis suggested the use of thromboprophylaxis in patients with VTE risks between 8 and 20%.

Conclusion: We developed a novel and convenient tool that may assist clinicians in identifying patients whose VTE risk is high enough to warrant thromboprophylaxis.

Keywords: Acute myeloid leukemia; Nomogram; Predictor; Thrombosis; Venous thromboembolism.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of venous thromboembolism and death with confidence interval
Fig. 2
Fig. 2
Nomogram for venous thromboembolic event development. DVT, deep venous thrombosis; ECOG PS, Eastern Cooperative Oncology Group performance status; HCT CI, Hematopoietic Cell Transplantation-specific Comorbidity Index; PT, prothrombin time
Fig. 3
Fig. 3
(A) Prediction performance and (B) cross-validated calibration plots of the clinical prediction model
Fig. 4
Fig. 4
Decision-curve analysis for primary thromboprophylaxis in AML. The probability threshold represents the predicted risk of venous thromboembolism in AML for recommending primary thromboprophylaxis. The net clinical benefit balances the risk of venous thromboembolism with the potential harms of unnecessary thromboprophylaxis, which was calculated as the true-positive rate minus the weighted false-positive rate
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