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    Caprini Score for Venous Thromboembolism (2005)

    Stratifies risk of VTE in surgical patients.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients undergoing surgery.

    • May not be applicable to medical patients.
    • Requires face-to-face physician/patient interaction (not computer- or note-based) to obtain historical factors.
    • Validated in many subsets of surgical patients, including general, plastic, vascular, head and neck, surgical ICU, and others (see Evidence Appraisal for details).
    • The most widely validated VTE risk assessment model in surgical patients.
    • Stratifies risk for VTE and provides validated recommendations for who should be discharged with continued prophylaxis.
    ≤40
    0
    41-60
    +1
    61-74
    +2
    ≥75
    +3
    Male
    Female
    None
    0
    Minor
    +1
    Major >45 min, laparoscopic >45 min, or arthroscopic
    +2
    Elective major lower extremity arthroplasty
    +5
    Recent (<1 month) event
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    No
    0
    Yes
    +5
    No
    0
    Yes
    +5
    No
    0
    Yes
    +5
    No
    0
    Yes
    +5
    Venous disease or clotting disorder
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    No
    0
    Yes
    +3
    Normal, out of bed
    0
    Medical patient currently on bed rest
    +1
    Patient confined to bed >72 hours
    +2
    Other present and past history
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +2
    No
    0
    Yes
    +1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    While many hospitals have developed institution-wide policies for VTE prophylaxis based on risk assessment models, the decision for type and duration of VTE prophylaxis should ultimately be left up to the surgeon’s best clinical judgment based on individual patient factors.

    Formula

    Addition of the selected points:


    0 points

    1 point

    2 points

    3 points

    5 points

    Age (years)

    ≤40

    41-60

    61-74

    ≥75

    --

    Type of surgery

    --

    Minor

    Major >45 min, laparoscopic >45 min, arthroscopic

    --

    Elective major lower extremity arthroplasty

    Recent (<1 month) event

    None

    Major surgery, CHF, sepsis, pneumonia, pregnancy or postpartum (if female)

    Immobilizing plaster cast

    --

    Hip, pelvis, or leg fracture; stroke; multiple trauma; acute spinal cord injury causing paralysis

    Venous disease or clotting disorder

    None

    Varicose veins, current swollen legs

    Current central venous access

    History of DVT/PE, family history of thrombosis, positive Factor V Leiden, positive prothrombin 20210A, elevated serum homocysteine, positive lupus anticoagulant, elevated anticardiolipin antibody, heparin-induced thrombocytopenia, other congenital or acquired thrombophilia

    --

    Mobility

    Normal, out of bed

    Medical patient currently on bed rest

    Patient confined to bed >72 hours

    --

    --

    Other present and past history

    None

    History of inflammatory bowel disease, BMI >25, Acute MI, COPD, other risk factors, on oral contraceptives or hormone replacement

    (if female), history of unexplained stillborn, ≥3 spontaneous abortions, or premature birth with toxemia or growth-restricted infant (if female)

    Present or previous malignancy

    --

    --


    Facts & Figures

    Caprini Score

    Risk category

    Risk percent*

    Recommended prophylaxis**

    Duration of chemoprophylaxis

    0

    Lowest

    Minimal

    Early frequent ambulation only, OR at discretion of surgical team:

    Pneumatic compression devices OR graduated compression stockings

    During hospitalization

    1–2

    Low

    Minimal

    Pneumatic compression devices ± graduated compression stockings

    During hospitalization

    3–4

    Moderate

    0.7%

    Pneumatic compression devices ± graduated compression stockings

    During hospitalization

    5–6

    High

    1.8%

    Pneumatic compression devices AND low dose heparin OR low molecular weight heparin

    7–10 days total

    7-8

    High

    4.0%

    Pneumatic compression devices AND low dose heparin OR low molecular weight heparin

    7–10 days total

    ≥9

    Highest

    10.7%

    Pneumatic compression devices AND low dose heparin OR low molecular weight heparin

    30 days total

    *From Pannucci 2017.

    **From Bahl 2010.

    Evidence Appraisal

    The original Caprini Score for VTE was developed in 1991 by Joseph Caprini and colleagues, who studied 538 patients admitted for surgery including general, urologic, orthopedic, gynecologic, and head and neck procedures. Twenty weighted risk factors were obtained from a face-to-face history and a total risk score obtained, and patients were stratified into low, moderate, and high risk depending on the score.

    Although no protocol for prophylaxis was studied in the original derivation, the Caprini Score has since been validated in multiple separate cohorts, including plastic and reconstructive surgery (Pannucci 2011), surgical critical care (Obi 2015), thyroid and parathyroid surgery (Macht 2017), ear/nose/throat surgery (Shuman 2012), foot and ankle surgery (Saragas 2014), and others.

    Pannucci et al in 2017 published a meta-analysis including 14,776 patients in 11 studies and found that VTE risk varied from 0.7% to 10.7% among surgical patients who did and did not receive chemoprophylaxis, respectively. Patients with higher Caprini Scores were significantly more likely to have VTE, and those with Caprini Scores of >7 had significant reduction in VTE risk (OR 0.60, 95% CI 0.37-0.97 for Caprini Score 7 and OR 0.41, 95% CI 0.26-0.65 for Caprini Scores ≥8) after surgery with chemoprophylaxis.

    The Caprini Score is the risk assessment model recommended by the 2012 Chest guidelines for VTE prevention.

    Literature

    Original/Primary Reference

    Research PaperCaprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost. 1991;17 Suppl 3:304-12.Research PaperBahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-50.Research PaperObi AT, Pannucci CJ, Nackashi A, Abdullah N, Alvarez R, Bahl V, Wakefield TW, Henke PK. Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients. JAMA Surg. 2015 Oct;150(10):941-8. doi: 10.1001/jamasurg.2015.1841.Research PaperPannucci CJ, Swistun L, Macdonald JK, Henke PK, Brooke BS. Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis. Ann Surg. 2017;Research PaperMacht R, Gardner I, Talutis S, Rosenkranz P, Doherty G, Mcaneny D. Evaluation of a Standardized Risk-Based Venous Thromboembolism Prophylaxis Protocol in the Setting of Thyroid and Parathyroid Surgery. J Am Coll Surg. 2017;Research PaperLobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord. 2016;4(2):153-60.Research PaperPannucci CJ, Bailey SH, Dreszer G, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg. 2011;212(1):105-12.Research PaperShuman AG, Hu HM, Pannucci CJ, Jackson CR, Bradford CR, Bahl V. Stratifying the risk of venous thromboembolism in otolaryngology. Otolaryngol Head Neck Surg. 2012;146(5):719-24.Research PaperSaragas NP, Ferrao PN, Saragas E, Jacobson BF. The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery. Foot Ankle Surg. 2014;20(2):85-9.
    Dr. Joseph Caprini

    About the Creator

    Joseph A. Caprini, MD, is a clinical professor of surgery at the Pritzker School of Medicine at the University of Chicago. He is also the Louis W. Biegler Chair of Surgery at NorthShore University HealthSystem in Evanston, Illinois. Dr. Caprini has authored or co-authored more than 385 articles, book chapters, and abstracts on the study and treatment of venous thromboembolism, venous insufficiency, and related topics.

    To view Dr. Joseph Caprini's publications, visit PubMed