Predicting venous thromboembolism risk after TACE in hepatocellular carcinoma: a logistic model and nursing protocol development.

Objective

To identify risk factors for venous thromboembolism (VTE) after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC), and to establish a personalized risk prediction nomogram.

Methods

A single-center retrospective analysis was performed on 322 consecutive HCC patients who received TACE at Baoji Central Hospital from December 2020 to December 2024. Patients were categorized into a VTE group (n=54) and a non-VTE group (n=268) based on the occurrence of VTE within 7 days post-procedure. Demographic, clinical, and laboratory data were gathered. Pearson correlation and variance inflation factor analyses were applied to evaluate multicollinearity, while logistic regression was used to identify independent risk factors. A nomogram and dynamic prediction model were developed from regression coefficients to quantify individualized risk and guide a structured five-phase nursing intervention plan.

Results

Multivariate analysis revealed that elevated D-dimer (DD) levels (OR=1.006), age ≥60 years (OR=0.361), Child-Pugh class C (OR=0.371), ECOG performance score 1-2 (OR=0.361), and multiple TACE sessions (OR=2.847) were independent predictors of post-TACE VTE (all P<0.05). The nomogram showed good calibration and strong discrimination (AUC=0.828). The decision-curve analysis also showed that it had a good net clinical benefit. The developed nursing protocol incorporates risk assessment, dynamic DD monitoring, early mobilization, hepatic function support, and patient education to facilitate risk management.

Conclusion

D-dimer level, age, Child-Pugh classification, ECOG status, and the frequency of TACE are all important factors affecting post-TACE VTE. The suggested prediction model is accurate and useful in clinical practice, offering valuable insights into early VTE risk stratification and perioperative safety assessment.