Caprini Model Research Articles

Performance of Risk Assessment Models for VTE in Patients Who Are Critically Ill Receiving Pharmacologic Thromboprophylaxis: A Post Hoc Analysis of the Pneumatic Compression for Preventing VTE Trial

BackgroundThe diagnostic performance of the available risk assessment models for venous thromboembolism in critically ill patients receiving pharmacologic thromboprophylaxis is unclear. Research QuestionFor critically ill patients receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop venous thromboembolism or who could benefit from adjunctive pneumatic compression for thromboprophylaxis? Study Design and MethodsIn this post hoc analysis of the PREVENT trial, we evaluated different risk assessment models for venous thromboembolism (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and IMPROVE models). We constructed receiving operator characteristic curves and calculated the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Additionally, we conducted subgroup analyses evaluating the effect of adjunctive pneumatic compression versus none on the study primary outcome. ResultsAmong 2003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed venous thromboembolism. With multivariable logistic regression analysis, the independent predictors of venous thromboembolism were APACHE II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve <0.60 except for the Caprini model (0.64, 95% confidence interval 0.60, 0.68). The Caprini, Padua and Intermountain models had high sensitivity (>85%) but low specificity (<20%) for predicting venous thromboembolism, whereas ICU-VTE, Kucher, and IMPROVE models had low sensitivities (<15%), but high specificities (>85%). The positive predictive value was low (<20%) for all studied cutoff scores, whereas the negative predictive value was mostly >90%. Using the risk assessment models to stratify patients into high- versus low-risk subgroups, the effect of adjunctive pneumatic compression versus pharmacologic prophylaxis alone was not different across the subgroups (p for interaction >0.05). InterpretationThe risk assessment models for venous thromboembolism performed poorly in critically ill patients receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression.

Impact of Clinical Decision Support with Mandatory versus Voluntary Venous Thromboembolism Risk Assessment in Hospitalized Patients.

Background Venous thromboembolism (VTE) causes significant preventable morbidity and mortality in hospitalized patients. Assessing VTE risk is essential to initiating appropriate prophylaxis and reducing VTE outcomes. Studies show that computerized clinical decision support (CDS) can improve VTE risk assessment (RA), prophylaxis, and outcomes but few examined the effectiveness of specific design features. From 2008 to 2016, University of Michigan Health implemented CDS for VTE prevention in four stages, which alternated between voluntary and mandatory RA using the 2005 Caprini model and generated inpatient orders for risk-appropriate prophylaxis based on CHEST guidelines. This cross-sectional study evaluated the impact of mandatory versus voluntary RA on VTE prophylaxis and outcomes for adult medical and surgical patients admitted to the health system. Methods Interrupted time series analysis was conducted to evaluate the trend in smart order set-recommended VTE prophylaxis by CDS stage. Logistic regression with CDS stage as the primary independent variable was used in pairwise comparisons of VTE during hospitalization and within 90 days post-discharge for mandatory versus voluntary RA. Adjusted odd ratios (ORs) were calculated for total, in-hospital, and post-discharge VTE. Results In this study of 223,405 inpatients over 8 years, smart order set-recommended prophylaxis increased from 65 to 79%; it increased significantly when voluntary RA in Stage 1 became mandatory in Stage 2 (10.59%, p < 0.001) and decreased significantly when it returned to voluntary in Stage 3 (-11.24%, p < 0.001). The rate increased slightly when mandatory RA was reestablished in Stage 4 (0.23%, p = 0.935). Adjusted ORs for VTE were lower for mandatory RA versus adjacent stages with voluntary RA. The adjusted OR for Stage 2 versus Stage 1 was 14% lower ( p < 0.05) and versus Stage 3 was 11% lower ( p < 0.05). The adjusted OR for Stage 4 versus Stage 3 was 4% lower ( p = 0.60). These results were driven by changes in in-hospital VTE. By contrast, the incidence of post-discharge VTE increased in each successive stage. Conclusion Mandatory RA was more effective in improving smart order set-recommended prophylaxis and VTE outcomes, particularly in-hospital VTE. Post-discharge VTE increased despite high adherence to risk-appropriate prophylaxis, indicating that guidelines for extended, post-discharge prophylaxis are needed to further reduce VTE for hospitalized patients.

Validation of a pulmonary embolism risk assessment model in gynecological inpatients

ObjectiveTo compare the predictive efficacy of the PADUA and Caprini models for pulmonary embolism (PE) in gynecological inpatients, analyze the risk factors for PE, and validate whether both models can effectively predict mortality rates.MethodsA total of 355 gynecological inpatients who underwent computed tomography pulmonary angiography (CTPA) were included in the retrospective analysis. The comparative assessment of the predictive capabilities for PE between the PADUA and Caprini was carried out using receiver operating characteristic (ROC) curves. Logistic regression analysis was used to identify risk factors associated with PE. Additionally, Kaplan–Meier survival analysis plots were generated to validate the predictive efficacy for mortality rates.ResultsAmong 355 patients, the PADUA and Caprini demonstrated the area under the curve (AUC) values of 0.757 and 0.756, respectively. There was no statistically significant difference in the AUC between the two models (P = 0.9542). Multivariate logistic analysis revealed immobility (P < 0.001), history of venous thromboembolism (VTE) (P = 0.002), thrombophilia (P < 0.001), hormonal treatment (P = 0.022), and obesity (P = 0.019) as independent risk factors for PE. Kaplan–Meier survival analysis demonstrated the reliable predictive efficacy of both the Caprini (P = 0.00051) and PADUA (P = 0.00031) for mortality. ROC for the three- and six-month follow-ups suggested that the Caprini model exhibited superior predictive efficacy for mortality.ConclusionsThe PADUA model can serve as a simple and effective tool for stratifying high-risk gynecological inpatients before undergoing CTPA. The Caprini model demonstrated superior predictive efficacy for mortality rates.

Risk factor analysis and prediction model construction for surgical patients with venous thromboembolism: A prospective study

Abstract Objective: Patients undergoing surgery are at high risk of developing venous thromboembolism (VTE). This study aimed to determine the predictive value of risk factors for VTE in surgical patients and to develop a prediction model by integrating independent predictors. Methods: A total of 1111 patients who underwent surgery at clinical departments in a tertiary general hospital were recruited between May and July 2021. Clinical data, including patient-related, surgery-related, and laboratory parameters, were extracted from the hospital information system and electronic medical records. A VTE prediction model incorporating ten risk variables was constructed using artificial neural networks (ANNs). Results: Ten independent factors (X1: age, X2: alcohol consumption, X3: hypertension, X4: bleeding, X5: blood transfusions, X6: general anesthesia, X7: intrathecal anesthesia, X8: D-dimer, X9: C-reactive protein, and X10: lymphocyte percentage) were identified as associated with an increased risk of VTE. Ten-fold cross-validation results showed that the ANN model was capable of predicting VTE in surgical patients, with an area under the curve (AUC) of 0.89, a Brier score of 0.01, an accuracy of 0.96, and a F1 score of 0.92. The ANN model slightly outperformed the logistic regression model and the Caprini model, but a DeLong test showed that the statistical difference in the AUCs of the ANN and logistic regression models was insignificant (P&gt;0.05). Conclusion: Ten statistical indicators relevant to VTE risk prediction for surgical patients were identified, and ANN and logistic regression both showed promising results as decision-supporting tools for VTE prediction.

Nomogram model combined thrombelastography for venous thromboembolism risk in patients undergoing lung cancer surgery.

Background: The aim of this study was to develop a nomogram model in combination with thromboelastography (TEG) to predict the development of venous thromboembolism (VTE) after lung cancer surgery. Methods: The data of 502 patients who underwent surgical treatment for lung cancer from December 2020 to December 2022 were retrospectively analyzed. Patients were then randomized into training and validation groups. Univariate and multivariate logistic regression analyses were carried out in the training group and independent risk factors were included in the nomogram to construct risk prediction models. The predictive capability of the model was assessed by the consistency index (C-index), receiver operating characteristic curves (ROC), the calibration plot and decision curve analysis (DCA). Results: The nomogram risk prediction model comprised of the following five independent risk factors: age, operation time, forced expiratory volume in one second and postoperative TEG parameters k value(K) and reaction time(R). The nomogram model demonstrated better predictive power than the modified Caprini model, with the C-index being greater. The calibration curve verified the consistency of nomogram between the two groups. Furthermore, DCA demonstrated the clinical value and potential for practical application of the nomogram. Conclusion: This study is the first to combine TEG and clinical risk factors to construct a nomogram to predict the occurrence of VTE in patients after lung cancer surgery. This model provides a simple and user-friendly method to assess the probability of VTE in postoperative lung cancer patients, enabling clinicians to develop individualized preventive anticoagulation strategies to reduce the incidence of such complications.

Caprini Model Integration into an Electronic Medical Record to Improve Perioperative Venous Thromboembolism Prophylaxis.

This quality-improvement retrospective cohort study of patients undergoing major elective nononcologic gynecologic surgery compares the proportion of patients receiving appropriate perioperative venous thromboembolism (VTE) chemoprophylaxis before and after a novel integration of the Caprini risk-assessment model (RAM) into the electronic medical record (EMR). A sample size of 83 patients in each group (166 total) was calculated to provide 80% power and show a 20% increase in appropriate administration of VTE prophylaxis, with an alpha of 0.05. Heparin was appropriately used in 24 patients (28.9%) in the pre-Caprini-RAM group and 39 patients (47.0%) in the post-Caprini-RAM group ( P =.016). There were no differences in bleeding events, transfusions, or other secondary outcomes. Integrating the Caprini-RAM into an EMR for patients undergoing nononcologic gynecologic surgery significantly improved appropriate use of VTE chemoprophylaxis.

Comparison and Validation of Different Risk Assessment Models in Patients with Venous Thromboembolism During Pregnancy and Postpartum: A Retrospective Study in China.

Venous thromboembolism (VTE) causes maternal mortality and morbidity. This study compares the predictive performance of three risk assessment models (Caprini model, Wells Score, and RCOG model) for VTE risk in Chinese patients during pregnancy and postpartum. We conducted a retrospective study in Nanfang Hospital of Southern Medical University and the Third Affiliated Hospital of Guangzhou Medical University from January 2003 to January 2022. Patients were risk-classified using the three risk assessment models, and the models were evaluated for accuracy. A total of 302 patients with confirmed VTE during pregnancy and postpartum were identified. Of these, 142 (47.0%) were diagnosed during pregnancy and 160 (53.0%) postpartum. A total of 276 (91.4%) patients had DVT only, 14 (4.6%) had PE only, and 12 (4.0%) were diagnosed with both. Of the 142 antepartum patients, 140 were categorized at moderate or above-risk levels by the Caprini model, 134 in the Wells Score model, and 112 in the RCOG model, respectively. The number of postpartum patients at moderate or above-risk levels identified by the Caprini, Wells Score, and RCOG models were 160, 152, and 118. The Caprini model significantly stratified VTE patients into a moderate or high-risk level (p < 0.05, Friedman Test). The Caprini model was also more effective at assessing the risk of VTE among postpartum patients than antepartum patients (p < 0.05, Friedman Test). We have demonstrated that the Caprini model is an effective prediction tool for the maternal population during peripartum, especially in the postpartum period. Results from the Caprini model will help obstetricians or physicians stratify potential risk patients and guide prophylaxis decisions. The RCOG model was not particularly useful in Chinese VTE patients during pregnancy and postpartum. Multicenter prospective validations of the RCOG model in Chinese maternal populations are needed.

Postoperative venous thromboembolism risk stratification in patients with uterine cancer

Uterine cancers are associated with a high risk for venous thromboembolisms. The American Society of Clinical Oncology practice guidelines recommend that all patients undergoing pelvic surgery for cancer should receive extended pharmacologic thromboprophylaxis with the duration being dependent on risk. However, risk stratification for patients with uterine cancer is not clearly defined. The Caprini score is the most widely used risk assessment model but it has been found to have limited use in the gynecologic oncology population. A modified Caprini score has been explored in other populations. The Khorana score is an additional risk assessment model that has not been studied in this context. Our objective was to evaluate the ability of a modified Caprini model and the Khorana score to risk stratify patients with uterine cancer for postoperative venous thromboembolisms within 90 days of surgery. Following institutional review board approval, a retrospective cohort study was performed, and all patients with uterine cancer who underwent a hysterectomy over a 4-year period were included. The Caprini and Khorana scores were calculated for each patient. The Caprini score cutoff for highest risk was evaluated at ≥7, ≥8, and ≥9 (modified Caprini) and the Khorana score cutoff was evaluated at ≥2 and ≥3. To determine the prognostic use of each score and other clinico-pathologic criteria related to the development of a venous thromboembolism, univariate analyses were performed using independent ttests, chi-square tests, or Fisher's exact tests; a multivariate analysis was performed using logistic regression. A total of 954 patients were included. The rate of venous thromboembolism development was 1.7% (16/954). A minimally invasive surgical approach was used in 90.5% (863/954) of patients. The mean Caprini score for patients with a venous thromboembolism was 10.3 compared with 8.1 for patients without a venous thromboembolism (95% confidence interval, 1.17-3.33; P<.0001). The mean Khorana score for the venous thromboembolism group was 2.4 vs 1.9 for those without (95% confidence interval, 0.04-0.82; P=.03). Both the Caprini and Khorana scores were found to be associated with venous thromboembolisms, but only a Caprini score with a cutoff of ≥8 or ≥9 was statistically significant (risk ratio, 31.25; 95% confidence interval, 1.88-519.49; risk ratio, 4.59; 95% confidence interval, 1.49-14.13, respectively), with high accuracy based on the area under the curve (0.75 and 0.68, respectively). Of the minimally invasive subgroup, 11.7% (101/863) of patients had same-day discharge with no postoperative thromboprophylaxis; none of these patients developed venous thromboembolisms. Despite extended prophylaxis among the laparotomy patients (30 days), the rate of venous thromboembolisms was more than 3 times that of the minimally invasive group (5.49% vs 1.7%). Advanced tumor stage and leukocytosis were noted to be independent risk factors for venous thromboembolisms. Our study suggests that using a modified Caprini score could help to identify the highest-risk patients who would benefit from prolonged thromboprophylaxis, could reduce the incidence of postoperative venous thromboembolisms, and could minimize the cost and harm of overtreatment. These findings need to be validated in a prospective manner, and further research is needed to determine the optimal duration of therapy.

Comorbid conditions increase the incidence of venous thromboembolism after colorectal surgery

Colorectal surgery (CRS) patients are at high risk for venous thromboembolism (VTE). The Caprini model elucidates that comorbidities compound to increase VTE risk, but this association in CRS patients remains undefined. We hypothesize that the compounding presence of comorbidities in patients undergoing colorectal resection (CRR) or small bowel resection (SBR) is associated with greater postoperative VTE risk. This study was a single-institution, retrospective review of patients undergoing CRR and/or SBR from July 2011 to July 2020. Patient demographics, baseline laboratory values, medical comorbidities, and 30-day outcomes were recorded. Incidence of 30-day preoperative or postoperative VTE, including deep venous thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), or inferior vena cava thrombosis (IVCT), were determined. All patients received multimodal in-hospital VTE prophylaxis. After July 2017, patients at high risk for VTE received post-discharge extended chemoprophylaxis. A total of 4354 patients were identified; 129 patients had a postoperative VTE. There was a high incidence of pre-existing comorbidities. In multivariate analysis, acute kidney injury ( p = 0.002) and preoperative 30-day VTE ( p <0.001), American Society of Anesthesiologists classification IV ( p = 0.015) and V ( p = 0.041), and inherited hypercoagulability states ( p = 0.029) were associated with postoperative VTEs. In a logistic regression model, multiple comorbidities ( p <0.001) and preoperative VTE ( p <0.001) were predictive of postoperative VTE. Open SBR ( p = 0.004) and open ( p = 0.001) and laparoscopic ( p <0.001) colectomy were associated with postoperative VTE. After July 2017, there were lower rates of postoperative VTE ( p = 0.041). Multimorbidity is linearly associated with increased rates of postoperative VTE after CRS surgery. This high-risk population could benefit from novel in-hospital and post-hospital VTE prophylaxis measures.

Venous thromboembolism risk assessment of surgical patients in Southwest China using real-world data: establishment and evaluation of an improved venous thromboembolism risk model

BackgroundVenous thromboembolism (VTE) risk assessment in surgical patients is important for the appropriate diagnosis and treatment of patients. The commonly used Caprini model is limited by its inadequate ability to discriminate between risk stratums on the surgical population in southwest China and lengthy risk factors. The purpose of this study was to establish an improved VTE risk assessment model that is accurate and simple.MethodsThis study is based on the clinical data from 81,505 surgical patients hospitalized in the Southwest Hospital of China between January 1, 2019 and June 18, 2021. Among the population, 559 patients developed VTE. An improved VTE risk assessment model, SW-model, was established through Logistic Regression, with comparisons to both Caprini and Random Forest.ResultsThe SW-model incorporated eight risk factors. The area under the curve (AUC) of SW-model (0.807 [0.758, 0.853], 0.804 [0.765, 0.840]), are significantly superior (p = 0.001 and p = 0.044) to those of the Caprini (0.705 [0.652, 0.757], 0.758 [0.719, 0795]) on two test sets, but inferior (p < 0.001 and p = 0.002) to Random Forest (0.854 [0.814, 0.890], 0.839 [0.806, 0.868]). In decision curve analysis, within threshold range from 0.015 to 0.04, the DCA curves of the SW-model are superior to Caprini and two default strategies.ConclusionsThe SW-model demonstrated a higher discriminative capability to distinguish VTE positive in surgical patients compared with the Caprini model. Compared to Random Forest, Logistic Regression based SW-model provided interpretability which is essential in guarantee the procedure of risk assessment transparent to clinicians.

An abbreviated Caprini model for VTE risk assessment in trauma.

The Caprini risk assessment model (RAM) is widely used to assess risk of venous thromboembolism (VTE). However, it is cumbersome with 31 variables and poses challenges with inter-rater reliability. This study aimed to determine if an abbreviated model could perform similarly in VTE risk assessment. We performed a retrospective review of trauma patients ≥ 18years old and admitted for over 24h at a Level I trauma center from January 1, 2018, to December 31, 2018. Demographic and clinical data were analyzed to generate Caprini scores. Using a p-value cutoff of < 0.05, the individual components of the original Caprini RAM most highly associated with VTE were identified and used to calculate an abbreviated Caprini score. Logistic regression assessed odds of inpatient VTE with the original or abbreviated Caprini RAMs. Receiver operating characteristic curves and c-statistics were generated to assess discriminatory ability. The study sample included 1279 patients. Ten risk factors were included in the abbreviated model (recent major surgery, length of surgery > 2h, transfusion, restricted mobility > 72h, central venous catheter, current major surgery, age, history of VTE, hip or leg fracture, and serious trauma). Compared to the original, the abbreviated model had a similar odds ratio (1.17 vs 1.07, both p-values < 0.001), c-statistic (0.747 vs 0.753), sensitivity (0.73 vs 0.76) and specificity (0.62 vs 0.61). An abbreviated Caprini RAM performs similarly to the original, may streamline workflow and allow for automation in electronic health records, potentially enhancing its use in resource limited settings.

Robotic-assisted hiatal hernia repair and pulmonary embolism: an institution-based retrospective cohort study.

Hiatal hernia (HH) is an abnormal protrusion of components of the abdominal viscera through the esophageal hiatus. The laparoscopic approach is the gold standard for repair with the robotic technique now gaining wide acceptance. Pulmonary embolism (PE) is a well-known post-operative complication but its incidence following robotically assisted HH repairs is not well known. This study provides a descriptive analysis of three patients who developed PE after robotic repairs of their HHs. The incidence of PE in the studied cohort was 2.7% (3 of 112) with a male preponderance (66.7%). The mean age of the patients was 55.3years with a mean BMI of 32.2kg/m2. The average duration of surgery was 4.2h with sizes of the diaphragmatic defects ranging from 3 to 6cm. Confirmatory PE diagnosis was made with a chest CT angiogram and the mean length of hospital stay was 4days. PE although rare, is a preventable cause of in-patient mortality and morbidity with implications on healthcare costs and hospital resource use. The Caprini model provides a guide to pre-operative patient risk stratification and PE prevention, and the patients in this study were in the moderate to high-risk groups. Risk factors common to all patients were: age > 40years, BMI > 30kg/m2 and duration of surgery > 2h with one of the patients having a previous history of PE. There are no established PE chemoprophylaxis guidelines for robotic HH repairs and in this cohort, heparin was commenced 6-8h post-operatively. Thus, there is a need for a consensus chemoprophylaxis guideline in this subset of surgical patients. PE following robotic HH repair is associated with prolonged hospital stay and increased healthcare costs. Guidelines for effective pre-operative chemoprophylaxis for these repairs are needed to optimize patient outcomes.

Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series

Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice. A retrospective chart review identified patients who underwent microsurgical breast reconstruction from January 2007 through December 2018. Patients with VTE diagnosed within 90 days of surgery were included. Demographics, co-morbidities, signs and symptoms, and characteristics of oncologic, surgical, and post-operative care were analyzed. Seven hundred one patients underwent microsurgical breast reconstruction. Eleven patients with pulmonary embolism (PE) and four with deep vein thrombosis (DVT) were identified, resulting in VTE incidence of 2.1% (0.57% DVT, 1.6% PE). Patients were on average 51 years old and had an average body mass index (BMI) of 31.7 kg/m2. Two had a history of VTE, and none had a known hypercoagulable disorder. Using the 2005 Caprini model, all were high risk and seven were highest risk. Among those with PE, the most common symptom was shortness of breath, and the most common signs were desaturation or supplemental oxygen requirements. VTE was diagnosed on average 14.2 days post-operatively (range 2-52 days). VTE is an infrequent complication following abdominally based microsurgical breast reconstruction. We recommend a high index of suspicion in women reporting shortness of breath or having desaturation, especially in those with high BMI, high Caprini scores, post-operative complications, or early return to the operating room.

Current prophylaxis and treatment of venous thromboembolism in intensive care units of 41 tertiary hospitals of Zhejiang Province

To investigate the prophylaxis and treatment of venous thromboembolism (VTE) in intensive care units (ICU) in Zhejiang Province. A cross-sectional questionnaire survey for ICUs doctors was conducted online at 41 tertiary hospitals in Zhejiang Province, which included basic information of ICUs, VTE-related installations, knowledge and monitoring system. The data collected from the questionnaire were summarized and analyzed. Most ICUs were comprehensive. The ratio of physicians to beds, ratio of nurses to beds, and the ratio of rehabilitation physicians to beds were 0.52∶1, 2.12∶1, and 0.03∶1 respectively. Thirty-five over 41 (85.4%) ICUs completed VTE risk assessment within 24 hours. Twenty-five over 35 ICUs (71.4%) chose the Caprini model to assess VTE risk. Ultrasound was preferred in 92.7% (38/41) of ICUs equipped ultrasound. Almost all (40/41, 97.6%) of hospitals possessed intermittent pneumatic compression (IPC) as mechanical prophylaxis. The ratio of IPC to bed was 0.22∶1. Low-molecular-weight heparin (92.7%, 38/41) was the initial treatment in ICUs. VTE prophylaxis system has been established in 92.7% (38/41)hospitals and 87.8% (36/41) ICUs,related personnel groups were set up in 75.6% (31/41) hospitals and 58.5% (24/41) ICUs including 68.3% (28/41) hospitals with multidisciplinary team. VTE prophylaxis system in different hospitals was heterogeneous. VTE risk assessment models in different ICUs were not identical. There were unmet clinical needs of VTE mechanical prophylaxis equipment. In conclusion, VTE screening, evaluation and prophylaxis protocols in ICUs still need to be standardized and improved.

Application of the Caprini risk assessment model for deep vein thrombosis among patients undergoing laparoscopic surgery for colorectal cancer.

Application of the Caprini risk assessment model was explored in patients with deep vein thrombosis (DVT) after laparoscopic colorectal cancer surgery.This study was a prospective study. The risk factors for DVT were assessed with a survey at baseline and on the morning of surgery, first day after surgery and sixth day by using repeated blood vessels on color Doppler ultrasound of the lower limbs, and the intraoperative and postoperative conditions were recorded.Among 148 surgical patients, 24.3% had asymptomatic DVT. According to the risk stratification, the incidence of DVT was related to the Caprini score (P < .001). The area under the curve of the Caprini model was 0.701 ± 0.047 (95% CI: 0.609–0.793, P<.001). The Youden index was 0.368, while the critical point was 10.5 in the Caprini model, corresponding to a sensitivity of 0.806 and a specificity of 0.563. Age, cardiovascular disease, intraoperative blood loss, postoperative fever, preoperative preparation, and hospital stay were higher in DVT patients than in patients without DVT. Moreover, the incidence of DVT in patients with a lithotomy position was higher than that in patients with a scissors position. In binary logistic regression analysis, the independent risk factors for DVT development were age, intraoperative blood loss, and preoperative preparation time.The Caprini model can be used for the prediction of venous thromboembolism in laparoscopic colorectal cancer surgery patients. The thrombosis risk assessment model must be established in line with patients undergoing endoscopic malignant tumor surgery.

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery-Prospective Observational Study.

Background: An invasive phlebological treatment is still not free from complications such as thrombosis. As in other surgical populations, not only the treatment modality, but also patient condition-related venous thromboembolism (VTE) risk factors matter. The current protocols used in varicose vein surgery centers are based mostly on individual risk assessment as well as on an implementation and extrapolation of general surgery VTE prophylaxis guidelines. In the presented study, the efficacy of routine VTE pharmacological thromboprophylaxis in patients undergoing saphenous varicose vein surgery was prospectively evaluated. In the result assessment, VTE risk factor evaluation and Caprini score results were included; however, due to the limited size of the projected study group, as well as expected limited deep vein thrombosis (DVT) prevalence in this clinical scenario, it was not possible to perform the validation of the Caprini model efficacy in the projected study model. Methods: In the study, 141 patients undergoing saphenous vein stripping and miniphlebectomy in spinal anesthesia were included. In all of the patients, VTE risk factors (including Caprini score evaluation) were assessed, and the routine thromboprophylaxis with enoxaparin 40 mg for 10 days was used. The venous ultrasounds were undertaken before the surgery and on the 10th and 30th day after surgery. The study endpoint was the presence of symptomatic or asymptomatic DVT confirmed in the imaging study. The study safety endpoint was major bleeding occurrence intraoperatively or within 30 days after surgery. Results: The presence of a postoperative DVT was diagnosed in five cases (3.5%) In all of these cases, only distal DVT was confirmed. Despite extensive saphenous varicose vein surgery with stripping and miniphlebectomy performed in nontumescent but spinal anesthesia, no proximal lower leg episode was diagnosed. Three out of five DVT cases were diagnosed on day 10 postoperative control, while a further two were confirmed in the ultrasound examination performed 30 days after procedure. No clinically documented pulmonaly embolism (PE) as well as no bleeding episodes were noticed. Among the factors related to the statistically significant higher DVT occurrence, the results of the Caprini score were identified with odds ratio (OR) = 2.04 (95% CI = (0.998; 4.18)). Another factor that became statistically significant in terms of the higher postoperative DVT prevalence was the reported Venous Clinical Severity Score (VCSS) results (OR = 1.98; 95% CI (1.19; 3.26)). In the multiple logistic regression analysis, the patient age (OR = 0.86; 95% CI (0.75–0.99)), Caprini score evaluation results (OR = 4.04; 95% CI (1.26–12.9)) and VCSS results (OR = 2.4; 95% CI (1.23–4.7)) were of statistical significance as predictors for postoperative DVT occurrence, with a p value of 0.029 for age, and p = 0.017 and p = 0.009 for Caprini score results and VCSS results, respectively. Due to the confirmed limited number of the DVT events in our study cohort, as well as the descriptive and explorative nature of the achieved results, the final clinical potential and significance of the identified parameters, including Caprini score rate and VCSS rate, should be interpreted with caution and studied in the further trials in these clinical settings. Conclusion: All the patients undergoing varicose vein surgery should undergo VTE risk evaluation based on the individual assessment. In VTE risk evaluation, patient and surgical procedure characteristics based on the factors included into the Caprini score but also on specific chronic venous disease-related factors should be taken into consideration. Further studies are needed to propose an objective and validated VTE risk assessment model, as well as a validated antithrombotic prophylaxis protocol in this particular patient group.

Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol

The incidence of symptomatic venous thromboembolism (VTE) has been reported in up to 10.9% of patients undergoing knee arthroscopy without chemoprohylaxis. The purpose of this study was to evaluate the effectiveness of a chemoprophylaxis protocol in patients undergoing knee arthroscopy. A retrospective review of prospectively enrolled patients in a new institutional VTE prophylaxis protocol identified all patients undergoing knee arthroscopy during a 5-year period. This risk-based chemoprophylaxis protocol was instituted based on the Caprini model: patients at more than minimal risk were prescribed enoxaparin 40 mg daily for 3 weeks, while all others were instructed to take aspirin 325 mg twice daily. The primary outcome measure was incidence of VTE within 60 days postoperatively. Demographic characteristics and other risk factors for VTE were also recorded, as well as any postoperative complications. Among the 1,276 knee arthroscopies, there were 26 VTE events (2.0%), including 23 with deep vein thrombosis (DVT), two pulmonary emboli (PE), and one patient with both DVT and PE. There were no deaths or complications requiring hospitalization or reoperation. The VTE diagnosis occurred at, on average, 9 days postoperatively. Patients in the high-risk group treated with enoxaparin had a lower VTE incidence (1.49%) than those instructed to take aspirin (2.0%); p = 0.75. Those undergoing an anterior cruciate ligament (ACL) reconstruction had the highest VTE incidence (2.87%). This study found that a chemoprophylaxis protocol with preferential use of aspirin or low-molecular weight heparin based on risk factors reduced the VTE incidence below to 2.0%, which is lower than most historical controls.

Predictive Value of Caprini Venous Thromboembolism Risk Assessment Model for Deep Vein Thrombosis in Intensive Care Unit Non-surgical Patients

Objective: By evaluating the relationship between deep vein thrombosis (DVT) in intensive care unit (ICU) non-surgical patients and Caprini venous thromboembolism risk assessment model (Caprini model for short), the predictive value of Caprini model in ICU non-surgical patients was analyzed. Methods: 200 ICU non-surgical inpatients in the first affiliated hospital of Jinan university from April to September 2019 were retrospectively analyzed. General data of patients and the number of new DVT events were collected, and Caprini model was used for scoring the risk of venous thromboembolism (VTE). Results: There were 31 patients with DVT, accounting for 15.50%, and 169 patients without new DVT (non-DVT). Caprini model score was 9.03±2.70 in patients with DVT, higher than that in patients without DVT (6.80±2.48, P&lt;0.001). 24 (12.00%) non-surgical ICU patients were at high risk of VTE and 171 cases (85.50%) were at very high risk. Only one patient with DVT was at high risk of VTE (3.23%), while the other 30 patients were at very high risk of VTE (96.77%). There were 1 case in low risk of VTE (0.59%), 4 cases in medium risk (2.37%), 23 cases in high risk (13.61%) and 141 cases in very high risk (83.43%) in non-DVT group. There was no significant difference in VTE risk stratification between DVT patients and non-DVT patients (P=0.063). The receiver operating characteristic (ROC) curve was plotted by using Caprini model score to predict DVT. The area under the ROC curve was 0.731, and the 95% confidence interval was 0.663-0.791 (P&lt;0.001). The optimal cut-off point was 7, the sensitivity was 74.19%, the specificity was 65.68% and Youden’s index was 0.3897. Conclusion: The incidence of high risk and very high risk of VTE in ICU non-surgical patients was high, and Caprini model could better predict the occurrence of DVT, so it was necessary to strengthen the nursing of ICU non-surgical patients and effectively prevent DVT.

Improving venous thromboembolism prophylaxis through critical thinking and health informatics

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalised patients. Mafraq Hospital, a 450-bed tertiary-level hospital in Abu Dhabi, United Arab Emirates, has identified VTE...

Risk assessment of venous thromboembolism based on Caprini model in lung cancer patients after thoracoscopic surgery

Objective To explore the risk assessment of venous thromboembolism (VTE) based on Caprini model in patients after thoracoscopic lobectomy and to analyze the related risk factors of VTE. Methods From January 2016 to January 2018, this study selected 42 early lung cancer patients with thoracoscopic lobectomy of Shandong Provincial Chest Hospital in control group, and selected 28 early lung cancer patients with VTE after surgery in observation group. This study also collected and compared the general information and the score of the Caprini risk assessment of patients between two groups, and analyzed the risk factors in the Caprini risk assessment model. Results The ages, preoperative fibrinogen, preoperative D-Dimer, the ratio of histories of malignant tumor, body mass index (BMI) ≥25 kg/m2, hypertension, hyperglycemia, lobectomy and smoking history of observation group were higher than those of control group with statistical differences (P<0.05) . The score of the Caprini risk assessment of observation group was higher than that of control group with statistical difference (P<0.01) . Multivariate analysis showed that risk factors of VTE of lung cancer patients after thoracoscopic surgery included the D-Dimer higher than critical value, smoking history and BMI≥25 kg/m2 with statistical differences (P<0.05) . Conclusions Caprini risk assessment model can effectively calculate the patients with VTE after thoracoscopic lobectomy, classify and quantize the incidence risk of deep vein thrombosis (DVT) . The high risk factors of patients with VTE after thoracoscopic lobectomy include the increased D-Dimer, overweight and heavy smoking. Key words: Venous thromboembolism; Thoracoscopes; Postoperative complications; Lobectomy; Caprini model; Risk assessment; Risk factors