Caprini Risk Assessment Model Research Articles

Effect of Risk-Graded Care Based on Caprini Risk Assessment Model on Postoperative Venous Thrombosis and Health-Related Quality of Life in Elderly Patients with Malignancy

Objective: To investigate the effect of risk-graded care based on Caprini risk assessment model on postoperative deep vein thrombosis and quality of life in elderly patients with malignant tumors.
 Methods: Sixty-eight elderly patients with malignant tumors treated by surgery admitted to the Department of Geriatrics of the First Affiliated Hospital of Sun Yat-sen University from April 2021 to September 2021 were selected to be included in the control group and given routine nursing interventions in the geriatrics department, using the Autar deep vein thrombosis risk scale and cluster nursing interventions; Seventy cases of elderly patients with malignant tumors treated by surgery admitted to our geriatric department from October 2021 to 2022 were included in the observation group, and the risk-grading nursing intervention based on the Caprini risk assessment model was used in the observation group on the basis of conventional nursing interventions. The number of cases of deep vein thrombosis, D-II cluster values, average hospitalization days, nursing satisfaction, and quality of life levels were compared between the two groups.
 Results: The number of VTE cases and the incidence of VTE in the observation group was 0.43%(3/70) lower than that in the control group (0.89%(6/68)); the average hospital stay in the observation group (13.50+7.45) was lower than that in the control group (15.16+10.60) and the D-II aggregation value in the observation group (2.90+4.32) was lower than that in the control group (4.02+3.91); with statistically significant differences (P<0.05); the satisfaction scores of communication, safety, guidance, nursing, and nursing techniques in the observation group were (41.70+4.21), (48.53+5.12), (38.47+1.90), (56.77+3.33), (47.80+1.68) points, higher than those in the control group (30.11+8.57), (41.69+7.95), (31.75+6.95), (46.87+7.31), (36.0+9.0) points, with statistically significant differences (t-values of -10.634 to -2.404, all P<0.05); the post-intervention scores of general health, physical function, physical function, somatic pain, somatic energy, social function, emotional function, mental health, and spiritual change dimensions of quality of life in the observation group were (67.00+14.95), (65.71+25.24), (63.21+21.59), (83.63+10.65), (74.43+13.45), (70.71+20.95), (67.62+26.60), (62.60+15.12) and (76.79+20.11) and scores were higher than the control group's post-intervention scores of (57.50+19.65), (40.44+27.33), (43.01+25.86), (54.57+15.42), (42.65+20.08), (56.25+26.67), (41.18+28.87), (52.35+18.86), (66.91+23.83) scores than the control group after intervention, with statistically significant differences (t-values of -26.878 to 0.989. all P<0.05).
 Conclusions: Risk-graded nursing intervention based on the Caprini risk assessment model can effectively reduce the incidence of postoperative VTE in elderly patients with malignancy, improve nursing satisfaction, and enhance the quality of life of patients.

Venous Thromboembolism Prophylaxis and Screening: A Clinical Audit

Objective: We aimed to audit venous thromboembolism in surgical patients at risk of VTE presented to surgical department in 2021 using the caprini risk assessment model. Methodology: This clinical audit was conducted in surgical D unit department of Surgery, Khyber Teaching Hospital, Peshawar from July 2021 to December 2021. A total of 150 patients each for the audit group and the re-audit group were selected through non-probability consecutive sampling for both genders. A predesigned proforma according to caprini risk assessment model was used to assess the patient’s individual risk for DVT and provision of appropriate prophylaxis. Data was entered into Microsoft excel, analyzed through SPSS version 23 and results were presented in the form of descriptive writing and tables. Results: The mean age of the study population was 50.47 with relatively equal selection from both genders. None of the patients in the audit group were properly grouped for their risk of DVT and management needed as mentioned in the caprini RAM guidelines. In the re-audit group, 100% of the patients were accurately categorized into groups and the VTE risk assessment percentage significantly improved from 0% to 80.8%. Conclusion: The audit showed noticeable deficiencies in record keeping and clinical assessment of VTE risk in the management of hospital patients. However, through appropriate measures this insufficiency can be amended with appreciable results.

Intervention strategy based on Caprini risk assessment model and its clinical effect in preventing deep vein thrombosis after total hip replacement

To analyze clinical effect of intervention strategies based on Caprini thrombosis risk assessment model for preventing deep vein thrombosis (DVT) after total hip replacement (THR). From January 2018 to December 2021, 197 patients with THR were selected as retrospective cohort study subjects, including 114 males and 83 females, aged from 45 to 80 years with an average of (66.81±10.34) years old. Caprini thrombosis risk assessment model introduced in May 2019 was used as boundary and divided into two groups, 94 patients were performed routine intervention strategies(control group) and 103 patients were received intervention strategies based on Caprini thrombosis risk assessment model (observation group). Incidence of DVT, visual analogue scale (VAS), circumference difference of affected limb, serum D-dimer (D-D) level and Harris score of hip function between two groups were analyzed. One-hundred and ninty-seven patients were followed up from 1 to 3 months with an average of (2.57±0.31) months. Incidence of DVT was 1.94% in observation group and 11.70% in control group, and there was statistical difference between two groups (χ2=6.642, P=0.010). VAS scores between two groups decreased gradually (P<0.001). There was significant difference between two groups in VAS score on the 1st, 2nd, 3rd and 7th day after operation (P<0.05), but no difference between two groups on the 10th day after operation (P>0.05). Difference in circumference of the affected limb between two groups after operation was gradually reduced (P<0.001), and the difference in circumference of the affected limb between two groups was statistically significant on the 1st, 2nd, 3rd, 7th, and 10th day after operation(P<0.05). Levels of serum D-D between two groups were gradually decreased after operation(P<0.05), and differences in serum D-D levels between two groups on the 8th, 24th, 48th, and 72th hour after operation were statistically significant (P<0.05). Pain score and Harris total scores between two groups were significantly increased as tomes goes on(P<0.001), no difference in VAS at 3 months after discharge, and there were statistically significant differences in Harris scores between two groups immediately after discharge, 1 month and 3 months after discharge (P<0.001). Intervention strategy based on Caprini thrombosis risk assessment model could reduce incidence of DVT in patients with THR, improve postoperative pain and swelling of the affected limb, and promote recovery of hip joint function.

Incidence of venous thromboembolism after surgery for adenocarcinoma in situ and the validity of the modified Caprini score: A propensity score-matched study.

BackgroundRecently, the new World Health Organization (WHO) tumor classification removed adenocarcinoma in situ (AIS) from the diagnosis of lung cancer. However, it remains unclear whether the “malignancy” item should be assessed when the modified Caprini Risk Assessment Model (RAM) is used to assess venous thromboembolism (VTE) risk in AIS. The purpose of our study is to assess differences between AIS and stage IA adenocarcinoma (AD) from a VTE perspective.MethodsA retrospective study was performed on AIS and IA adenocarcinoma in our hospital from January 2018 to December 2021, and divided into AIS group and AD group. Propensity score matching (PSM) was used to compare the incidence of VTE and coagulation function, and to analyze whether the RAM is more effective when the “malignancy” item is not evaluated in AIS.Results491 patients were included after screening, including 104 patients in the AIS group and 387 patients in the AD group. After PSM, 83 patients were matched. The incidence of VTE and D-dimer in the AIS group was significantly lower than that in the AD group (P<0.05).When using the RAM to score AIS, compared with retaining the “malignancy” item, the incidence of VTE in the intermediate-high-risk group was significantly higher after removing the item (7.9% vs. 36.4%, P=0.018), which significantly improved the stratification effect of the model.ConclusionsThe incidence of postoperative VTE in AIS was significantly lower than that in stage IA adenocarcinoma. The stratification effect was more favorable when the “malignancy” item was not evaluated in AIS using the RAM.

Risk assessment and compliance with hospital guidelines for venous thromboprophylaxis after gynecological surgeries

Background and objective: Venous thromboembolism after gynecological surgery is a major cause of morbidity and mortality. This study aimed to determine the venous thromboembolism risk profile of women who underwent gynecological surgery at a tertiary hospital and review the prescribed venous thromboembolism prophylaxis. Methods: An audit review study was conducted on 490 women who underwent major and minor gynecological surgeries at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from 1st December 2019 to 31st December 2020, regarding their risk of developing postoperative venous thromboembolism using the 2013 modified Caprini venous thromboembolism risk assessment model to determine their risk and the correct thromboprophylaxis prescription. Results: According to appropriate thromboprophylaxis administration of low molecular weight heparin, it was administered to two-thirds of the women. It was sufficient in 33.1% of the women, and only 8.2% of the women received it for the correct duration. The probability of incorrect decision was higher for the major surgeries than for minor surgeries [odds ratio (OR) = 15.5; 95% confidence interval (95% CI) =3.01–80.1]. Moderate risk carried a much higher probability of an incorrect decision than low risk (OR = 196.8; 95%CI = 30.4–1270.5), whereas the association with high risk was not significant. When low molecular weight heparin was administered, there was a higher probability of a wrong decision than when low molecular weight heparin was not administered (OR = 26.4; 95%CI = 7.1–97.6). Conclusion: The gynecologists' adherence to venous thromboembolism prophylaxis after major and minor gynecological surgeries at the hospital mandates more training for all healthcare providers. Keywords: Audit; Thromboprophylaxis; Caprini RAM 2013; Adherence to guidelines; Gynecological surgery.

The application of Caprini Risk Assessment Model in evaluation of deep vein thrombosis for patients with end-stage osteoarthritis before arthroplasty

BackgroundDeep vein thrombosis (DVT) was a fatal complication of knee arthroplasty. We had neglected the risk factors of preoperative DVT although patients undergoing knee arthroplasty were at high risk for VTE. This study was to determine the risk factors for preoperative DVT and application of Caprini Risk Assessment Model (RAM) in patients with end-stage knee osteoarthritis (OA).MethodsWe retrospectively analyzed 1808 cases with end-stage knee OA undergoing primary knee arthroplasty from May 2015 to December 2020. Based on the results of ultrasonography in lower extremities, all patients were divided into non-DVT group and DVT group. Distribution of risk factors and risk levels were compared using χ2 test between two groups. Binary logistic regression analysis was used to determine the risk factors and relationship of risk levels and preoperative DVT.ResultsThe incidence of preoperative DVT was 5.53% (n = 100). Distribution of the study population by risk level was low, 4.09%; moderate, 23.95%; high, 66.98%; and highest 4.98%. Female (P = 0.002), age (P = 0.012), swollen legs (P = 0.035) and history of blood clots (P < 0.001) was correlated with preoperative DVT. Difference among four risk levels was significant (P = 0.007). Patients with highest risk level had statistically significant association with preoperative DVT (P = 0.005, OR = 2.93, 95%CI [1.375–6.246]).ConclusionThe incidence of preoperative DVT was 5.53% in end-stage knee OA patients. The gender (female) and age were independent risk factors for preoperative DVT. The risk group classification by Caprini RAM was significantly associated with preoperative DVT. The usage of Caprini RAM before knee arthroplasty may be beneficial for prophylaxis of DVT.

Prevalence of venous thromboembolism and evaluation of a modified caprini risk assessment model: a single-centre, prospective cohort study involving patients undergoing lung resections for bronchiectasis

BackgroundVenous thromboembolism (VTE) is a common postoperative complication in general thoracic surgery, but the incidence of patients undergoing surgery for bronchiectasis was not known. The purpose of our study was to investigate the incidence of VTE in bronchiectasis patients undergoing lung resection and to evaluate the risk stratification effect of the modified caprini risk assessment model (RAM).MethodsWe prospectively enrolled patients with bronchiectasis who underwent lung resection surgery between July 2016 and July 2020.The postoperative duplex lower-extremity ultrasonography or(and) computed tomographic pulmonary angiography (CTPA) was performed to detect VTE. The clinical characteristics and caprini scores of VTE patients and non-VTE patients would be compared and analyzed. Univariate logistic regression was performed to evaluate whether higher Caprini scores were associated with postoperative VTE risk.In addition, We explored the optimal cutoff for caprini score in patients with bronchiectasis by using the receiver operating characteristic (ROC) curve.ResultsOne hundred and seventeen patients were eligible based on the prospective study criteria. The postoperative VTE incidence was 8.5% (10/117). By comparing the clinical characteristics and Caprini scores of VTE and non-VTE patients, the median preoperative hospitalization (7 vs 5 days, P = 0.028) and Caprini score (6.5 vs 3,P < 0.001) were significantly higher in VTE patients. In univariate logistic regression, a higher Caprini score was associated with higher odds ratio (OR) for VTE of 1.7, 95% confidence interval (CI) was from 1.2 to 2.5 (P = 0.001), C-statistics was 0.815 in the modified caprini RAM for predicting VTE. In a multivariable analysis adjusting for preoperative hospitalization, a higher Caprini score was associated with higher odds OR for VTE of 1.8 (95%CI: 1.2–2.6, P = 0.002), C-statistics was 0.893 in the caprini RAM for predicting VTE. When taking the Caprini score as 5 points as the diagnostic threshold, the Youden index is the largest.ConclusionsThe postoperative VTE incidence in patients undergoing lung resection for bronchiectasis was 8.5%.The modified caprini RAM effectively stratified bronchiectasis surgery patients for risk of VTE and showed excellent predictive power for VTE. The patients with postoperative caprini scores = 5, should be recommended to take positive measures to prevent postoperative VTE.Trial RegistrationChinese Clinical Trial Register: ChiCTR-EOC-17010577.

Thrombotic complications after radiofrequency and cyanoacrylate endovenous ablation: Outcomes of a multicenter real-world experience

ObjectiveChronic venous insufficiency (CVI) affects >40% of the U.S. population; thus, intervention for symptomatic venous disease comprises a large portion of many vascular practices. The treatment of superficial CVI has evolved from open surgical treatment to minimally invasive endovenous closure, including both thermal and nonthermal techniques. Thrombotic complications of thermal ablation have been well reported, with an overall complication rate of <2%. However, a paucity of high-powered, real-world data is available on the thrombotic outcomes of nonthermal techniques. In the present study, we compared the incidence of endovenous heat-induced thrombosis (EHIT) and endovenous glue-induced thrombosis (EGIT) in a large cohort of patients with CVI. MethodsA retrospective review was conducted at two tertiary-level institutions of patients who had undergone superficial endovenous ablation from 2018 to 2021. The patient demographics, comorbidities, and periprocedural outcomes were collected through medical record review. A Caprini risk assessment model score was assigned using the information available from the electronic medical records. The patients were categorized by procedure type (ClosureFast [Medtronic Inc, Minneapolis, MN] radiofrequency ablation [RFA] vs VenaSeal [Medtronic Inc] cyanoacrylate glue closure [CAG]). The primary end point was the incidence of EHIT or EGIT. The secondary end point was the incidence of deep vein thrombosis and/or pulmonary embolism. ResultsA total of 803 patients had undergone 1096 procedures during the study period. Their mean age was 62 ± 15 years, and 67% were women. Of the 1096 procedures, 700 were RFA and 396 were CAG procedures, with a combined closure rate of 98% by postprocedure duplex ultrasound at 7 days. The average Caprini score was 5.2 ± 1.8 (RFA, 5.0; vs CAG, 5.4; P < .001). The incidence of EHIT and EGIT was 1.9% and 1.3%, respectively (P = .57). The deep vein thrombosis rate was 0.1% in the RFA cohort and 0.3% in the CAG cohort (P = .81). A comparative analysis of thermal vs nonthermal techniques was performed. A univariate analysis of the risk factors for EHIT and EGIT revealed no significant factors predisposing to thrombotic events. ConclusionsThe results from the present study have demonstrated the safety of RFA and CAG closure techniques for CVI, with lower thrombotic rates than previously reported. Further work might help to identify how these results can be achieved across all venous ablative techniques for CVI, even for patient populations with advanced venous disease and possibly a greater than average risk of thrombotic events.

Should all patients receive extended thromboprophylaxis after resection of primary lung cancer?

ObjectiveThe optimal duration of thromboprophylaxis in patients undergoing resection of primary lung cancer is not known. We investigated the incidence of pulmonary emboli and venous thromboembolism in patients undergoing early-stage lung cancer resection and the impact of change from short duration to extended thromboprophylaxis. MethodsWe reviewed the outcomes of consecutive patients who underwent resection of early-stage primary lung cancer following a change in protocol from inpatient-only to extended thromboprophylaxis to 28 days. Propensity-score matching of control (routine inpatient pharmacologic thromboprophylaxis) and treatment group (extended pharmacologic thromboprophylaxis) was performed. Adjustment for covariates based on the Caprini risk assessment model was undertaken. Thromboembolic outcomes were compared between the 2 groups. ResultsSeven hundred fifty consecutive patients underwent resection of primary lung cancer at Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018. Six hundred patients were included for analysis and propensity-score matching resulted in 253 matched pairs. Extended prophylaxis was associated with a significant reduction in pulmonary emboli (10 of 253 patients [4%] vs 1 of 253 patients [0.4%], P = .01). One patient (0.4%) developed a bleeding complication within the treatment cohort. Multivariable logistic regression model demonstrated that extended thromboprophylaxis was independently associated with a reduction in postoperative pulmonary emboli. ConclusionsPatients undergoing lung cancer resection surgery are at moderate-to-high risk of postoperative thromboembolic disease. Extended dalteparin for 28 days is safe and is associated with reduced incidence of pulmonary embolus in patients undergoing resection of early-stage primary lung cancer.

Control study of the intelligent calculation method and the traditional calculation method in risk assessments of hospitalization

To explore the accuracy of intelligent calculation (IC) method for risk assessment of hospitalization for patients, aiming to build a more advantageous risk assessment system. The "Search Engine" program was developed based on hospital information system (HIS) of the Fifth Center Hospital in Tianjin, which automatically captured patient information and generated nutritional risk screening 2002 (NRS 2002) score, Caprini thrombosis risk assessment model and Padua thrombosis risk assessment model for venous thromboembolism (VTE), the CHA2DS2-VASc for predicting stroke risk stratification in atrial fibrillation and the HAS-BLED for predicting bleeding risk in anticoagulated patients with atrial fibrillation. A randomized controlled trial was conducted. According to the applicable conditions of each risk assessment, 100 risk scores from "Search Engine" program belonged to each risk assessment were randomly selected, defined as the IC group. Manual scoring with the data of the same case at the same time, defined as the traditional calculation (TC) group, compared the consistency of the scores and the difference in time-consuming between the two groups. The Bland-Altman plots showed that the 95% limits of agreement (95%LoA) of NRS 2002 score, Caprini score, Padua score, CHA2DS2-VASc score and HAS-BLED score was -0.46 to 0.41, -0.49 to 0.52, -0.50 to 0.41, -0.67 to 0.60, -0.44 to 0.43, respectively, all P > 0.05. In this study, the Bland-Altman plot showed that 95%, 96%, 97%, 97%, 95% plots fell within the 95%LoA in NRS 2002 score, Caprini score, Padua score, wwCHA2DS2-VASc score and HAS-BLED score by the two methods, respectively. The all plots of 95%LoA were within the clinically acceptable range (-0.5 to 0.5 scores). The time-consuming of NRS 2002 score, Caprini score, Padua score, CHA2DS2-VASc score and HAS-BLED score in IC group were significantly shorter than those in TC group [0.72 (0.71, 0.73) seconds vs. 361.02 (322.41, 361.02) seconds, 0.72 (0.72, 0.73) seconds vs. 196.68 (179.99, 291.20) seconds, 0.72 (0.72, 0.73) seconds vs. 105.75 (92.32, 114.70) seconds, 0.72 (0.71, 0.72) seconds vs. 72.66 (56.24, 84.20) seconds, 0.72 (0.71, 0.72) seconds vs. 51.30 (38.88, 57.15) seconds, respectively, all P < 0.001]. For the above five risk assessments, the TC method and IC method has good consistency in scores, and the IC method is faster, which has good application prospect for clinical application.

The Risk Factors for Preoperative and Postoperative Deep Vein Thrombosis in Surgical Patients

Objective: This paper investigated the risk of preoperative and postoperative deep vein thrombosis (DVT) in surgical patients.Methods: The sample consisted of 377 patients of the general surgery, orthopedics and traumatology, neurosurgery, and cardiovascular surgeryclinics of a university hospital. Data were collected using a demographic characteristics questionnaire, the Deep Vein Thrombosis DiagnosticCriteria Form, the Autar Deep Vein Thrombosis Risk Assessment Scale, the Caprini Risk Assessment Model, and the Padua Prediction Score. Thedata were analyzed using descriptive analysis.Results: According to the Autar Deep Vein Thrombosis Risk Assessment Scale, most participants were in the “low risk” category in thepreoperative period (91%), and more than a quarter of the participants were in the “high risk” category in the postoperative period (30%).According to the Caprini Risk Assessment Model, less than half of the participants were in the “moderate risk” group in the preoperativeperiod (39%), and more than half the participants were in the “high risk” group in the postoperative period (70.6%). According to the PaduaPrediction Score, most participants were in the “low risk” category in the preoperative period (82.2%), and more than half the participants werein the “high risk” group in the postoperative period (52.8%). More than half the participants who used graduated compression stocks in thepreoperative period misused them (62.7%). A bit more than half the participants who used graduated compression stocks in the postoperativeperiod used them correctly.Conclusion: The results show that surgical patients are at a higher risk for deep vein thrombosis in the postoperative period than in thepreoperative period.

Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study

To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA). A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group, and 172 patients without DVT after TKA in the same period according to the 1∶4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data, score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model. The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12), P<0.001];DVT group was mainly at medium and high risk group(66.67%), while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI≥30 kg/m2, lower extremity edema (<1 month), severe pulmonary disease (<1 month), acute myocardial infarction (<1 month), bed rest (> 2 h), history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380), BMI≥30 kg/m2(OR=2.518), lower extremity edema(<1 month)(OR=7.652), acute myocardial infarction (<1 month) (OR=1.994), bed rest (> 72 h)(OR=3.897), history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification, respectively. Caprini MRAM can be used to predict the risk of DVT in patients after TKA, especially for patients with high risk.

Construction and Verification of Risk Predicting Models to Evaluate the Possibility of Venous Thromboembolism After Robot-Assisted Radical Prostatectomy

BackgroundVenous thromboembolism (VTE) is the second leading cause for death of radical prostatectomy. We aimed to establish new nomogram to predict the VTE risk after robot-assisted radical prostatectomy (RARP).MethodsPatients receiving RARP in our center from November 2015 to June 2021, were enrolled in study. They were randomly divided into training and testing cohorts by 8:2. Univariate and multivariate logistic regression (model A) and stepwise logistic regression (model B) were used to fit two models. The net reclassification improvement (NRI), integrated discrimination improvement (IDI), and receiver operating characteristic (ROC) curve were used to compare predictive abilities of two new models with widely used Caprini risk assessment (CRA) model. Then, two nomograms were constructed and received internal validation.ResultsTotally, 351 patients were included. The area under ROC of model A and model B were 0.967 (95% confidence interval: 0.945–0.990) and 0.978 (95% confidence interval: 0.960–0.996), which also were assayed in the testing cohorts. Both the prediction and classification abilities of the two new models were superior to CRA model (NRI > 0, IDI > 0, p < 0.05). The C-index of Model A and Model B were 0.968 and 0.978, respectively. For clinical usefulness, the two new models offered a net benefit with threshold probability between 0.08 and 1 in decision curve analysis, suggesting the two new models predict VTE events more accurately.ConclusionsBoth two new models have good prediction accuracy and are superior to CRA model. Model A has an advantage of less variable. This easy-to-use model enables rapid clinical decision-making and early intervention in high-risk groups, which ultimately benefit patients.

Incidence of Deep Venous Thrombosis (DVT) in Head and Neck Cancer Patients Receiving IV Fluids (IVF) via Peripheral IV (PIV) Compared to Central Venous Catheter

<h3>Purpose/Objective(s)</h3> Venous thromboembolism (VTE) is a common complication among cancer patients with a reported incidence close to 15% per year.^(1-3) One study found a VTE risk of 18.3% in the head and neck (H&N) cancer population using the Caprini risk assessment model.⁴ Up to 66% of VTE occurring in the upper extremity are due to intravenous catheters.⁵ This implies that recurring IV access for hydration would induce a clinically significant level of endothelial inflammation resulting in a higher risk of VTE. Therefore, patients with H&N cancer undergoing chemoradiotherapy who require repeated IV insertion for IV hydration appear to be at an increased risk for DVTs. We wanted to estimate the risk of DVT among H&N cancer patients undergoing regular IV hydration via peripheral IV as opposed to central venous catheter (CVC) to see if CVC use reduces the risk of DVT. <h3>Materials/Methods</h3> A retrospective database was created for patients at our institution from CY2019 to CY2020 who had a diagnosis of H&N cancer. We recorded the type of cancer, presence and location of DVT, if they were receiving IVF and if so, via CVC or PIV, and treatment received (chemo +/- XRT). We analyzed the number of patients who developed DVT and evaluated if there was a difference in incidence of DVT between those who received IVF through PIV or CVC. <h3>Results</h3> Out of 72 patients with H&N cancer, 7 were found to have DVT (9.7%). 57% of patients developed upper extremity DVT and 43% lower extremity. Two with DVT also had pulmonary embolus. 57% of patients were receiving IVF 2-3 times/week via PIV, 14% were receiving IVF through CVC, and the remaining 29% did not receive IVF. Out of these 7 patients who developed DVT, 6 (85.7%) were receiving both chemotherapy and radiation at the time of DVT, and the remaining patient was not receiving cancer treatment. <h3>Conclusion</h3> The data show a significant incidence of VTE among H&N cancer population. The preliminary data also shows an increased incidence of DVT among those receiving IVF via PIV compared to CVC, which supports a change of hydration protocol from PIV to CVC. Further prospective data will be obtained to add to the analysis.

Prolonged Venous Thromboembolism Prophylaxis May Not Be Necessary for DIEP Flap Breast Reconstruction: A Tertiary Center's 10-Year Experience.

Based on the 2005 Caprini Risk Assessment Model for venous thromboembolism, the American Society of Plastic Surgeons prevention guidelines would result in prolonged chemoprophylaxis (1 week or more) for the majority of patients undergoing deep inferior epigastric perforator flap breast reconstruction. We aim to assess the necessity of prolonged prophylaxis by describing our institutional experience in thromboembolism prevention and evaluating the incidence of symptomatic VTE in our patient cohort. Women who underwent DIEP flap reconstruction from August 2011 to March 2020 at a tertiary care center were included. Charts were retrospectively reviewed for patient characteristics, VTE prophylaxis regimens, and development of deep vein thrombosis and pulmonary embolism within 60 days of surgery. Caprini scores were calculated for all patients. Out of the 249 patients included in the study, 245 patients received chemoprophylaxis only during hospitalization, while four patients additionally received anticoagulant for at least 2 weeks after discharge for prophylactic or therapeutic indications. The cohort's average Caprini score was 6.0, with 72.7% of scores between 3 and 6 and 26.5% at 7 or higher. One patient (0.4%), who scored a 7 and received prophylaxis only while hospitalized, developed deep vein thrombosis. There were no cases of pulmonary embolism. There was no significant difference in VTE rate between patients who received chemoprophylaxis consistent with ASPS guidelines and those who did not (p = 1.000). Despite our limited chemoprophylaxis use in DIEP flap patients, our VTE incidence is low. This current work suggests that the blanket application of prolonged prophylaxis is not warranted, and it further serves as impetus to re-evaluate the 2005 Caprini RAM in this patient population.

Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

Background. Venous thromboembolism (VTE) is regarded as the most preventable cause of inpatient death in hospital settings globally. VTE can be prevented through the provision of non-pharmacological and/or pharmacological thromboprophylaxis following individualised risk screening. The Caprini risk assessment model (RAM) offers a validated and well-established approach for VTE risk assessment in medical inpatients. Literature findings describe a trend towards inappropriate and under-prescribing of thromboprophylaxis in this population. Together with concerns regarding clinicians’ perceived importance of VTE risk assessment, the need to clarify these aspects of practice is evident. Objectives. To describe VTE risk assessment and prophylaxis practices of medical practitioners in public sector hospitals in Western Cape Province, South Africa (SA). Methods. A retrospective, cross-sectional study design was employed in the medical wards of two district hospitals and one regional hospital in the Cape Town metropole, Western Cape. Medical folders of adult medical inpatients admitted between January and July 2020 were reviewed to assess VTE risk using the Caprini RAM. Thromboprophylaxis therapy prescribed and contraindications to chemoprophylaxis were also evaluated. Results. Of 380 patients included in the review, 51.6% were female, and the average age was 52.1 years (range 18 - 96); 21.3% had their weight recorded, while none had their height documented. Infectious disease was the predominant diagnosis (49.2%) detected in the sample. Common VTE risk factors identified included bed rest/restricted mobility for &lt;72 hours (76.3%) and serious infection (67.4%). A total of 97.1% of patients (n=369) were found to be at moderate or higher risk of VTE (Caprini score ≥2). Of this at-risk group, 24.1% were eligible to receive chemoprophylaxis, yet no prescription for thromboprophylaxis was identified. Seventy percent of patients (n=266) were prescribed chemoprophylaxis, with enoxaparin accounting for 98.5% of regimens. Contraindications to chemoprophylaxis were recorded in 13.4% of patients. Conclusions. Although rates of VTE prophylaxis in medical inpatients may be improving, thromboprophylaxis still remains critically underutilised in this population. This study highlighted a consequence of this trend, with inappropriate chemoprophylaxis prescribing becoming more evident. Mechanical prophylaxis prescribing in medical inpatients is lacking, despite the associated benefits. RAMs should be adapted for the SA setting, where infectious diseases are prevalent. Future research should assess RAM use by clinicians, as this could provide insight into improving RAM uptake and thromboprophylaxis prescribing.

Validation of Risk Assessment Models Predicting Venous Thromboembolism in Inpatients with Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: A Multicenter Cohort Study in China

Inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at increased risk for venous thromboembolism (VTE); however, the prophylaxis for VTE is largely underused in China. Identifying high-risk patients requiring thromboprophylaxis is critical to reduce the mortality and morbidity associated with VTE. This study aimed to evaluate and compare the validities of the Padua Prediction Score and Caprini risk assessment model (RAM) in predicting the risk of VTE in inpatients with AECOPD in China. The inpatients with AECOPD were prospectively enrolled from seven medical centers of China between September 2017 and January 2020. Caprini and Padua scores were calculated on admission, and the incidence of 3-month VTE was investigated. Among the 3,277 eligible patients with AECOPD, 128 patients (3.9%) developed VTE within 3 months after admission. The distribution of the study population by the Caprini risk level was as follows: high, 53.6%; moderate, 43.0%; and low, 3.5%. The incidence of VTE increased by risk level as high, 6.1%; moderate, 1.5%; and low, 0%. According to the Padua RAM, only 10.9% of the study population was classified as high risk and 89.1% as low risk, with the corresponding incidence of VTE of 7.9 and 3.4%, respectively. The Caprini RAM had higher area under curve compared with the Padua RAM (0.713 ± 0.021 vs. 0.644 ± 0.023, p = 0.029). The Caprini RAM was superior to the Padua RAM in predicting the risk of VTE in inpatients with AECOPD and might better guide thromboprophylaxis in these patients.

Validation of a modified Caprini risk assessment model in lung cancer patients undergoing surgery: Results of a multicenter cross-sectional observational study.

Lung cancer patients slated for surgery are at high risk of venous thromboembolism (VTE). Precise risk assessment is necessary for providing proper thromboprophylaxis and reducing morbidity and mortality of VTE. A multicenter, observational, cross-sectional cohort study, involving patients with primary lung cancer undergoing surgery, was carried out from August 2016 to December 2019. All patients were assessed according to the Caprini risk assessment model (RAM) and a modified scoring system incorporating elevated D-dimer and new stratification of surgical time. The endpoint was confirmed VTE or patient discharge. Out of 1205 patients, 87 (7.2%) were diagnosed with VTE. The area under the curve of modified scores for VTE was 0.759, which was larger than that of the original one (0.589) (p < 0.05). By modified Caprini scoring system, a higher score was associated with increased VTE risk (odds ratio [OR], 1.345; 95% confidence interval [CI], 1.197-1.512; p < 0.001), and there was an increased OR of 4.090 (95% CI, 2.472-6.768, p < 0.001) for VTE in high-risk category patients. Modified Caprini RAM showed an improved prediction of high-risk patients with an elevated likelihood of postoperative VTE compared to the original one.

Application of the Caprini Risk Assessment Model to Select Patients for Extended Thromboembolism Prophylaxis After Sleeve Gastrectomy

BackgroundThe Caprini risk assessment model is a well-validated tool that identifies patients who would benefit from extended venous thromboembolism (VTE) prophylaxis beyond hospital discharge. VTE, particularly portal mesenteric vein thrombosis (PMVT), is a potentially devastating complication of laparoscopic sleeve gastrectomy (LSG); therefore, we sought to examine whether the model can be safely applied to LSG patients. We hypothesized that its use can minimize the incidence of postoperative VTE, including PMVT, without increasing the likelihood of bleeding complications. Materials and MethodsWe conducted a retrospective chart review of those patients who underwent LSG at our institution from 2010 and 2018, at which time the Caprini risk assessment model was already our institutional standard. We determined the patients’ Caprini scores at the time of discharge and whether patients at high risk of VTE were discharged from hospital on extended courses of VTE prophylaxis. We also recorded if bleeding complications or VTE events occurred in the first 180 days after LSG. ResultsSix hundred thirty-eight patients underwent LSG, including 521 (81.7%) women, with an average preoperative body mass index (BMI) of 44.4 kg/m2 (SD 6.8). One hundred fifty-eight (24.8%) patients had Caprini scores that warranted extended courses of VTE prophylaxis beyond hospital discharge. Three patients (0.47%) developed a postoperative VTE, but no patient developed PMVT. No bleeding complications were observed among patients who received extended VTE prophylaxis. ConclusionThe Caprini risk assessment model can effectively identify patients after LSG who might benefit from extended courses of VTE prophylaxis. Extended VTE prophylaxis does not seem to confer increased bleeding risk in this patient population.

Validation of two risk assessment models for venous thromboembolism in patients undergoing gynecologic surgery.

BackgroundAccording to published guidelines, gynecologic surgical patients should be stratified into different risk level groups to receive prophylaxis for venous thromboembolism (VTE), but the applicability of available risk assessment models (RAMs) in common gynecologic surgical patients remained to be confirmed. We aimed to validate the use of the Caprini RAM and gynecologic Caprini (G-Caprini) RAM for assessing postoperative VTE risk in gynecologic surgical patients.MethodsThe database of a randomized controlled trial (RCT) was used to select patients who underwent gynecologic surgeries for benignant and malignant diseases in five institutions in China between 2011 and 2018. The Caprini RAM version recommended by the American College of Chest Physicians (ACCP) was adopted. Participants were divided into four risk levels based on the Caprini and G-Caprini scores. For each risk level group, the incidence of VTE was calculated. The correlation between VET incidence and risk levels was assessed by Spearman’s rank correlation coefficient (RS) value.ResultsAs a result, 800 patients in the data base were analyzed with an overall VTE incidence of 5.8%. Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 0%, 4.3%, 44.4%, and 51.4%, respectively, and the VTE incidence was 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 0.500 (P=0.667). G-Caprini RAM showed that the percentage of patients at very low risk, low risk, moderate risk, and high risk were 7.8%, 28.0%, 32.0%, and 32.3%, respectively, and the VTE incidence was 0.0%, 2.9%, 2.3%, and 9.0%, respectively. RS value between the risk stratification and VTE incidence was 1.000 (P<0.01).ConclusionsThe G-Caprini RAM was as suitable as the Caprini RAM for VTE risk assessment in gynecologic surgical patients. The gynecologic model has the advantages of ease of use and more accurate identification of low-risk groups.