Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

Grant, Paul; Greene, M. Todd; Chopra, Vineet; Bernstein, Steven J.; Hofer, Timothy P.; Flanders, Scott A.

doi:10.1016/j.amjmed.2015.10.027

Cited by 104 publications

(108 citation statements)

References 20 publications

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“…The literature search produced 415 articles on December 17, 2017 (Figure ). After reviewing titles and abstracts, 12 RAMs from 11 developers were obtained to validate; the Padua prediction score, the electronic alert system by Kucher, the electronic alert system by Lecumberri, the NICE guideline, the PRETEMED guideline, the 4‐factor and 7‐factor predicted IMPROVE models, the Geneva risk score, model 2 as published by Zakai et al, the Intermountain risk score, the NAVAL score, and the Caprini risk assessment score . Almost all scores include the presence of active cancer and a previous venous thrombosis as predictors whereas, for example, predictors like ischemic stroke, lower‐limb paralysis or recent travel are included in only three RAMs.…”

Section: Resultsmentioning

confidence: 99%

“…Patients hospitalized for acute medical illness have an eightfold increased risk of venous thrombosis as opposed to the general population . As routine pharmacological thromboprophylaxis for all patients is not recommended due to the associated bleeding risk, risk assessment models (RAMs) have been developed to identify high‐risk patients . International guidelines recommend to prescribe thromboprophylaxis in selected high‐risk medical patients by use of these models…”

Section: Introductionmentioning

confidence: 99%

“…3 As routine pharmacological thromboprophylaxis for all patients is not recommended due to the associated bleeding risk, risk assessment models (RAMs) have been developed to identify high-risk patients. [4][5][6][7][8][9][10][11][12][13][14][15] International guidelines recommend to prescribe thromboprophylaxis in selected high-risk medical patients by use of these models. 2,7 However, for high-risk medical patients, thromboprophylaxis remains underused as shown in the ENDORSE study where medical patients at risk of venous thrombosis actually received thromboprophylaxis in only 48% of cases.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Cobben

Nemeth

Lijfering

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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Background Risk assessment models (RAMs) have been developed to predict which medical patients are at high risk for venous thrombosis (VT) and hence, should receive pharmacological thromboprophylaxis. Possibly due to the limited performance of the current models, guidelines differ on thromboprophylaxis regimens. Objective In this study all known RAMS were externally validated in medical patients in order to guide physicians in their thromboprophylaxis strategies. Patients and Methods A literature search was performed to find all published RAMs for medical patients at risk for VT. Data from a large population based case‐control study (MEGA study) designed to identify risk factors for a first VT were used to externally validate each RAM. Results 516 patients and 40 controls met the inclusion criteria for being a medical patient out of 4956 cases and 6297 controls). The c‐statistic, sensitivity, specificity, negative, and positive predictive values were calculated for each RAM. The literature search yielded 12 RAMs, none of which showed good discrimination (area under the curve range 0.56‐0.66), high sensitivity or specificity. The negative predictive value was high in all the RAMs (range 98.6‐99.4) and positive predictive value was low (range 1.1‐3.4). Conclusion This study shows that the discriminative power of currently available RAMs to predict VT in medical patients is limited. Therefore, clinical judgment should supplement RAMs to identify high‐risk medical patients for thromboprophylaxis. These results underline the importance of improving the performance of these models.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Cobben

Nemeth

Lijfering

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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“…To help stratify the risk of VTE in hospitalized patients, several RAMs have been suggested . Recently, the Caprini RAM and Padua prediction score have been used to evaluate the risk of VTE clinically and are adopted in “Antithrombotic therapy and prevention of thrombosis, 9th Ed: American college of chest physicians evidence‐based clinical practice guidelines.” The Caprini RAM, which was updated as a relatively mature model in 2010 from its first report in 1980, is configured with a total of 39 individual risk factors of VTE for valid assessment; thus, this RAM was adopted for VTE evaluation in many clinical studies except those on thrombosis involved in IBD . The Padua prediction score was based on the KucherÕs model, with slight modifications for which international guidelines strongly recommended thromboprophylaxis .…”

Section: Discussionmentioning

confidence: 99%

“…19 The Caprini RAM, which was updated as a relatively mature model in 2010 from its first report in 1980, is configured with a total of 39 individual risk factors of VTE for valid assessment; thus, this RAM was adopted for VTE evaluation in many clinical studies except those on thrombosis involved in IBD. [18][19][20][21] The Padua prediction score was based on the KucherÕs model, with slight modifications for which international guidelines strongly recommended thromboprophylaxis. 8 In this study, both RAMs were not found to be significantly associated with the occurrence of VTE by multivariate analysis; thus, these scoring systems were determined to not be useful in patients with IBD who needed hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a novel predictor of venous thromboembolic complications in inflammatory bowel disease with current predictors

Ohta

Arai

Nakagawa

et al. 2018

J of Gastro and Hepatol

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Risk Assessment Models for Venous Thromboembolism in Medical Inpatients

Häfliger,

Kopp,

Darbellay Farhoumand

et al. 2024

JAMA Netw Open

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ImportanceThromboprophylaxis is recommended for medical inpatients at risk of venous thromboembolism (VTE). Risk assessment models (RAMs) have been developed to stratify VTE risk, but a prospective head-to-head comparison of validated RAMs is lacking.ObjectivesTo prospectively validate an easy-to-use RAM, the simplified Geneva score, and compare its prognostic performance with previously validated RAMs.Design, Setting, and ParticipantsThis prospective cohort study was conducted from June 18, 2020, to January 4, 2022, with a 90-day follow-up. A total of 4205 consecutive adults admitted to the general internal medicine departments of 3 Swiss university hospitals for hospitalization for more than 24 hours due to acute illness were screened for eligibility; 1352 without therapeutic anticoagulation were included.ExposuresAt admission, items of 4 RAMs (ie, the simplified and original Geneva score, the Padua score, and the IMPROVE [International Medical Prevention Registry on Venous Thromboembolism] score) were collected. Patients were stratified into high and low VTE risk groups according to each RAM.Main Outcomes and MeasuresSymptomatic VTE within 90 days.ResultsOf 1352 medical inpatients (median age, 67 years [IQR, 54-77 years]; 762 men [55.4%]), 28 (2.1%) experienced VTE. Based on the simplified Geneva score, 854 patients (63.2%) were classified as high risk, with a 90-day VTE risk of 2.6% (n = 22; 95% CI, 1.7%-3.9%), and 498 patients (36.8%) were classified as low risk, with a 90-day VTE risk of 1.2% (n = 6; 95% CI, 0.6%-2.6%). Sensitivity of the simplified Geneva score was 78.6% (95% CI, 60.5%-89.8%) and specificity was 37.2% (95% CI, 34.6%-39.8%); the positive likelihood ratio of the simplified Geneva score was 1.25 (95% CI, 1.03-1.52) and the negative likelihood ratio was 0.58 (95% CI, 0.28-1.18). In head-to-head comparisons, sensitivity was highest for the original Geneva score (82.1%; 95% CI, 64.4%-92.1%), while specificity was highest for the IMPROVE score (70.4%; 95% CI, 67.9%-72.8%). After adjusting the VTE risk for thromboprophylaxis use and site, there was no significant difference between the high-risk and low-risk groups based on the simplified Geneva score (subhazard ratio, 2.04 [95% CI, 0.83-5.05]; P = .12) and other RAMs. Discriminative performance was poor for all RAMs, with an area under the receiver operating characteristic curve ranging from 53.8% (95% CI, 51.1%-56.5%) for the original Geneva score to 58.1% (95% CI, 55.4%-60.7%) for the simplified Geneva score.Conclusions and RelevanceThis head-to-head comparison of validated RAMs found suboptimal accuracy and prognostic performance of the simplified Geneva score and other RAMs to predict hospital-acquired VTE in medical inpatients. Clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies.

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Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

Abstract: Background-The optimal approach to assess risk of venous thromboembolism (VTE) in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model (RAM) predicts VTE in hospitalized medical patients.

Cited by 104 publications

References 20 publications

Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Comparison of a novel predictor of venous thromboembolic complications in inflammatory bowel disease with current predictors

Risk Assessment Models for Venous Thromboembolism in Medical Inpatients

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