Lessons Learned: Using the Caprini Risk Assessment Model to Provide Safe and Efficacious Thromboprophylaxis Following Hip and Knee Arthroplasty

Abstract

Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient’s risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care.

Artificial Intelligence-Based Prediction of Lower Extremity Deep Vein Thrombosis Risk After Knee/Hip Arthroplasty

“…After several revisions, the Caprini score has been successfully applied for the assessment of the risk of DVT after knee/hip arthroplasty. 13 , 25 However, in an analysis of 376 knee/hip arthroplasties by Bateman et al, 26 no significant difference was observed between the Caprini scores of patients with and without postoperative DVT. Bateman et al 27 had not recognised the importance of the risk of joint arthroplasty, as all patients had been categorised as high risk, with Caprini scores ≥ 5 points.…”

Incidence and Risk Factors for Superficial and Deep Vein Thrombosis in Post-Craniotomy/Craniectomy Neurosurgical Patients

“…Similar to the a priori risk factors selected in this study, the checklist includes items such as age, tumors, and PICC lines [16]. Although the Caprini model has a greater theoretical potential to prevent VTE, it is only efficacious if patient data are conscientiously analyzed and used to create real-time adjustments [17,18].…”

Rationales and uncertainties for aspirin use in COVID-19: a narrative review

“…1 These indications may be for arterial thrombosis prevention as mentioned above or for the prevention of VTE following total hip or knee replacement 46 after a risk assessment of postoperative VTE. 47 …”

“…1 These indications may be for arterial thrombosis prevention as mentioned above or for the prevention of VTE following total hip or knee replacement 46 after a risk assessment of postoperative VTE. 47 Prevention of severe acute respiratory distress syndrome in COVID-19 disease Before the COVID-19 era, several studies were conducted to investigate the role of aspirin in preventing ARDS in at-risk patients with conflicting results. A recent meta-analysis of 6764 at-risk patients across 7 studies concluded that prior aspirin use was associated with decreased incidence of ARDS in at-risk patients, but was not associated with decreased hospital mortality.…”