Role of rivaroxaban in arteriovenous graft thrombosis after endovascular treatment and establishment and evaluation of a nomogram predictive model for postoperative recurrent thrombosis risk

ObjectiveTo evaluate the role of rivaroxaban in preventing arteriovenous graft (AVG) thrombosis following endovascular intervention, assess the risk of recurrent thrombosis, and develop a clinically applicable predictive model.MethodsA retrospective analysis was performed on 108 patients with AVG thrombosis who underwent endovascular treatment at our center between October 2020 and October 2024. Patients were stratified into a rivaroxaban group (<i>n</i> = 71) and a control group (<i>n</i> = 37). Fifteen variables from the two groups were analyzed and summarized. Four machine learning algorithms (random forest, Support Vector Machine - Recursive Feature Elimination, Least Absolute Shrinkage and Selection Operator, and XGboost) were applied to identify risk factors for recurrent thrombosis. A predictive model was constructed using logistic regression and validated with an internal dataset.ResultsAmong the 108 patients, 69 were male and 39 were female, with ages ranging from 21 to 89 years. Fibrinogen levels were significantly lower in the rivaroxaban group (4.02 ± 0.87 vs. 4.59 ± 1.03, <i>p</i> < 0.01), More notably, the 12-month postprocedural patency rate was significantly higher in the rivaroxaban group (75%) than in the nonrivaroxaban group (17%), with a statistically significant difference (<i>p</i> < 0.01). No statistically significant differences were observed between the two groups in other aspects (<i>p</i> > 0.05). The model exhibited a C-index of 0.87 (95% CI: 0.78-0.95). The receiver operating characteristic and decision curve analysis curves demonstrated that the multifactor model had superior discriminative ability and net clinical benefit for identifying recurrent AVG thrombosis compared to single factors (AUC_{linear predictor}= 0.87, AUC_{rivaroxaban use}= 0.78, AUC_D-dimer= 0.60). Validation in the internal validation set and the entire cohort confirmed good calibration and efficacy (validation set: AUC = 0.86, entire cohort: AUC = 0.85).ConclusionRivaroxaban may exert a positive effect on maintaining the patency of AVG fistulas after endovascular treatment for thrombosis. The constructed nomogram prediction model can be used to predict the risk of recurrent thrombosis following endovascular treatment of AVG fistula thrombosis.