The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties

Abstract

Objective: Estimation of the specific thresholds of the Caprini risk score (CRS) that are associated with the increased incidence of venous thromboembolism (VTE) across different specialties, including identifying the highest level of risk. Background: Accurate risk assessment remains an important but often challenging aspect of VTE prophylaxis. One well-established risk assessment model is CRS, which has been validated in thousands of patients from many different medical and surgical specialties. Methods: A search of MEDLINE and the Cochrane Library was performed in March 2022. Manuscripts that reported on (1) patients admitted to medical or surgical departments and (2) had their VTE risk assessed by CRS and (3) reported on the correlation between the score and VTE incidence, were included in the analysis. Results: A total of 4562 references were identified, and the full text of 202 papers was assessed for eligibility. The correlation between CRS and VTE incidence was reported in 68 studies that enrolled 4,207,895 patients. In all specialties, a significant increase in VTE incidence was observed in patients with a CRS of ≥ 5. In most specialties thresholds of ≥ 7, ≥ 9, and ≥ 11 to 12 were associated with dramatically increased incidences of VTE. In cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥ 9 and ≥ 11 to 12 scores the VTE incidence was extremely high (ranging from 13% to 47%). Conclusion:The Caprini score is being used increasingly to predict VTE in many medical and surgical specialties. In most cases, the VTE risk for individual patients increases dramatically at a threshold CRS of 7 to 11.

Gynecological Cancer and Venous Thromboembolism: A Narrative Review to Increase Awareness and Improve Risk Assessment and Prevention

“…Although the Caprini score is the recommended risk assessment model for surgical patients, it is also widely used in medical ones. There is still a lack of proper validation of the Caprini score in many patient populations and clinical situations, and a recently published paper showed that the thresholds of the Caprini score associated with increased risk of venous thromboembolism may vary across different specialties within a score range of 7-11 [86]. Of note, among 68 studies that enrolled more than 4 million patients, only one was conducted in a mixed gynecological and urological surgical population of 783 patients.…”

The trends in venous thromboembolism occurrence and prevention after minimally invasive varicose vein surgery

“…[15][16][17] Among all, the Caprini risk score (CRS) is the most validated tool to predict postoperative VTE. [18][19][20] However, it has not yet been validated adequately in minimally invasive VV surgery. 20 Also, there is no evidence on the CRS thresholds that may be associated with the benefits of routine pharmacological prophylaxis in patients with VVs undergoing endovenous treatment.…”

Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper-Gastrointestinal and Hepatopancreatobiliary Surgery

“…General abdominal, colorectal, upper gastrointestinal (UGI), and hepatopancreatobiliary (HPB) surgery guidelines have failed to provide patient and procedure-specific guidance on pharmacological thromboprophylaxis, 7,[12][13][14][15][16][17] at least in part due to uncertainty regarding baseline risks that vary with patient and procedure-specific factors. 18 The absence of procedurespecific recommendations contributes to substantial practice variation within and between centers and countries. 12,[19][20][21][22][23][24][25] To provide risk estimates of VTE and major bleeding for general abdominal, colorectal, UGI, and HPB procedures, and thus to fill this knowledge gap, we conducted a series of systematic reviews.…”

“…General abdominal, colorectal, upper gastrointestinal (UGI), and hepatopancreatobiliary (HPB) surgery guidelines have failed to provide patient and procedure-specific guidance on pharmacological thromboprophylaxis, 7,12–17 at least in part due to uncertainty regarding baseline risks that vary with patient and procedure-specific factors 18 . The absence of procedure-specific recommendations contributes to substantial practice variation within and between centers and countries 12,19–25 .…”