Thrombosis prophylaxis in surgical patients using the Caprini Risk Score

Wilson, Spencer; Chen, Xialan; Cronin, MaryAnne; Dengler, Nancy; Enker, Paul; Krauss, Eugene S.; Laberko, Leonid; Lobastov, Kirill; Andrea, T.; Powell, Chloé; Rosenkranz, Pamela; Schastlivtsev, Ilya; Segal, Ayal; Simonson, Barry G.; Siracuse, Jeffrey J.; Wakefield, Thomas W.; McAneny, David; Caprini, Joseph A.

doi:10.1016/j.cpsurg.2022.101221

Cited by 22 publications

(7 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This further underscores the role of the Caprini RAM in TJA, highlighting its effectiveness in providing a reliable risk assessment for VTE occurrence. These findings align with results from studies conducted on other surgical procedures, 25,29 indicating a certain level of consistency in the predictive capabilities of the Caprini RAM across various surgical contexts.…”

Section: Discussionsupporting

confidence: 85%

“…However, the score for joint arthroplasty surgery is already 5, rendering it ineffective in providing a valuable risk warning. 24 However, the University of Michigan defines a score greater than 8 as “super-high risk.” 25 It is important to note that patients undergoing arthroplasty generally tend to be older and have higher baseline scores. As a result, the majority of postoperative patients in this population have Caprini scores exceeding 8 points.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism after Joint Arthroplasty

Qiao

Yao

et al. 2023

Thromb Haemost

View full text Add to dashboard Cite

Background: The Caprini risk assessment model (RAM) is the most commonly used tool for evaluating venous thromboembolism (VTE) risk, the high scoring for arthroplasty can result in patients being classified as high risk for VTE. Therefore, its value in post arthroplasty has been subject to debate. Methods: Retrospective data was collected from patients who underwent arthroplasty between August 2015 and December 2021. The study cohort included 3807 patients, all of whom underwent a thorough evaluation using Caprini RAM and vascular Doppler ultrasonography preoperatively. Results: 432 individuals (11.35%) developed VTE, while 3375 did not. 32 (0.84%) presented with symptomatic VTE, while 400 (10.51%) were detected as asymptomatic. Additionally, 368 (9.67%) VTE events occurred during the hospitalization period, and 64 (1.68%) cases were detected during post-discharge follow-up. Statistical analysis revealed significant differences between the VTE and non-VTE groups in terms of ages, blood loss, d-dimer, BMI>25, visible varicose veins, swollen legs, smoking, history of blood clots, broken hip, percent of female, hypertension and knee joint arthroplasty(P<0.05). The Caprini score was found to be significantly higher in the VTE group (10.10±2.23) compared to the non-VTE group (9.35±2.14) (P<0.001). Furthermore, there was a significant correlation between the incidence of VTE and the Caprini score (r=0.775, p=0.003). Patients with a score ≥9 are at a high-risk threshold for postoperative VTE. Conclusion: The Caprini RAM shows a significant correlation with the occurrence of VTE. A higher score indicates a greater likelihood of developing VTE. The score ≥9 is a particularly high risk of developing VTE.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism after Joint Arthroplasty

Qiao

Yao

et al. 2023

Thromb Haemost

View full text Add to dashboard Cite

show abstract

“…Among the variables, pharmacological thromboprophylaxis was de ned as treatment with enoxaparin at a dose of 40 mg subcutaneously per day, treatment with unfractionated heparin at a dose of 5000 U subcutaneously every 12 h, or dalteparin at a dose of 5000 U subcutaneously per day. Missed dose was de ned as the non-application of pharmacological thromboprophylaxis, although it was indicated according to the Padua prediction score (14) in medical patients or the Caprini score for venous thromboembolism (15) in surgical patients according to the data recorded in the medical history, either because it was not prescribed by the attending physician or because it was not applied by the nursing staff.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with the development of venous thromboembolic disease due to failed thromboprophylaxis.

Perez,

Talero,

Velandia

2023

Preprint

View full text Add to dashboard Cite

Introduction: Available evidence to identify factors independently associated with failed thromboprophylaxis (FT) in medical patients is insufficient. The present study seeks to evaluate in hospitalized patients, which clinical factors are associated for the development of FT. Materials and methods: A case-control study nested to a historical cohort, comparing patients who developed failed thromboprophylaxis (cases) with those who did not (controls). Univariate and multivariate regression analysis was performed to define the factors associated with FT. Results: We collected 204 cases and 408 controls (52.4% men, median age 63 years). Seventy-eight point four percent had indication for medical hospitalization. The most frequent thromboprophylaxis scheme was enoxaparin. In the failed thromboprophylaxis group, most of the embolic events corresponded to pulmonary thromboembolism (53.4%). Among cases, BMI was higher (26.3 vs 25 kg/m2, p<0.001), as was the proportion of patients with leukocytosis >13,000 (27% vs 18.9%, p:0.22), and the proportion who required intensive care management (48% vs 24.8%,p<0.001). Factors independently associated with FT were BMI (OR1.04;95%CI 1.00-1.09, p:0.39), active cancer (OR:1.63;95%IC 1.03-2.57,p:0.04), leukocytosis (OR:1.64;95%CI 1.05 - 2.57, p0.03) and ICU requirement (OR:3.67;95%CI 2.31-5.83,p<0.001). Conclusion: Our study suggests that the development of failed thromboprophylaxis is associated with elevated BMI, active cancer, leukocytosis and ICU requirement. Future studies should evaluate whether there is benefit in adjusting the thromboprophylaxis schedule in medical patients with one or more of these factors.

show abstract

“…The Caprini score -in comparison to other type of scores-proved its usefulness in identifying low-risk people who might not need prophylaxis, in addition to identifying high-risk individuals, this approach is similar to that of Spencer Wilson et al (2). In addition, more attention is being given to the potential for VTE occurrence after ambulatory procedures as operations move from inpatient to outpatient settings, and as the list of outpatient procedures grows, as does the chance that patients will have more VTE risk factors.…”

Section: Sterbling Et Al Who Studied Vte Incidence In Patients Publis...mentioning

confidence: 96%

An Audit of Perioperative VTE Risk Assessment and Prophylactic Anticoagulation

Elhassan,

Khalifa,

Alnimiery

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Venous thromboembolism (VTE) can arise following significant general surgery. Among hospitalized patients in the U.S, pulmonary embolism has been listed as the most common cause of death. Surgery itself is a risk factor for VTE, In the majority of required quality initiatives, preventing VTE is thought of as a patient safety strategy. Many approaches have been used in the fight against venous thromboembolism. These devices pharmaceutical products such as fondaparinux, low-molecular-weight heparin, and unfractionated heparin, as well as mechanical devices such as graded compression stockings (GCS) and intermittent pneumatic compression (IPC) devices. Most of the methods incorporate both of these methods. Patients undergoing surgery should receive VTE prophylaxis and the level of VTE prophylaxis for surgical patients needs to be in line with the anticipated risk. The total risk category is determined by the type of surgery and VTE risk factors. There are a number of published guidelines for determining VTE risk with widely divergent approaches. Numerous risk assessment scores exist, such as the Caprini RAM, Khorana score, and Padua score. Of these, the Caprini RAM was chosen for use in this audit because of its greater validity than the other assessment scores. In addition, the caprini score was found to be far more effective than the Khorana prediction score for identifying hospitalized individuals at risk of VTE. Moreover, 40% of patients with a high Caprini score had a non high Padua score, indicating that the Caprini score rather than the Padua score may be more appropriate for assessing VTE in surgical patients. Methods: An interview was performed with the surgical staff, consisting of interns and residents, who were responsible for preparing patients for surgery to obtain prospective data. The telephone or in-person interview took place in June or August 2021 and consisted of three questions with one response per question. Results: Following the application of the Caprini RAM, 71 (36.6%) of the 194 patients were at risk for deep vein thrombosis (DVT). A total of 123 (63.4%) of the patients did not recieve a score evaluation since the doctors in charge of getting the patients ready for the theatre were not aware of the VTE risk assessment. Ten patients (5%) in one unit were given prophylactic heparin before laparoscopic cholecystectomy, based more on personal experience than on a risk evaluation. Conclusion: It became clear that staff knowledge was below what was originally expected and more than 90% were not able to apply any VTE risk assessment scoring system. However, a surprisingly low number of staff said they were aware of the risk assessment scoring system for VTE but they were not applying this system either because they were not aware of the seriousness of the DVT or because they lacked the knowledge that peri-operative measures such as drugs for examples, can be given safely to patients at risks without major bleeding as a complication.

show abstract

Thrombosis prophylaxis in surgical patients using the Caprini Risk Score

Cited by 22 publications

References 98 publications

The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism after Joint Arthroplasty

The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism after Joint Arthroplasty

Factors associated with the development of venous thromboembolic disease due to failed thromboprophylaxis.

An Audit of Perioperative VTE Risk Assessment and Prophylactic Anticoagulation

Contact Info

Product

Resources

About