Caprini Risk Assessment Model Research Articles

Postoperative Venous Thromboembolism Prophylaxis Utilizing Enoxaparin Does Not Increase Bleeding Complications After Abdominal Body Contouring Surgery

Venous thromboembolism (VTE) chemoprophylaxis warrants an individualized, risk-stratified approach, and constitutes a relatively controversial topic in plastic surgery. The aim of this study was to determine the safety of a 7-day postoperative enoxaparin regimen for VTE prophylaxis compared with a single preoperative dose of heparin in abdominal body contouring surgery. This single-institution pre-post study investigated the safety of a 7-day enoxaparin postoperative regimen in abdominal body contouring procedures performed by a single surgeon from 2007 to 2018. Four procedures were included: traditional panniculectomy, abdominoplasty, fleur-de-lis panniculectomy, and body contouring liposuction. Group I patients received a single dose of 5000 U subcutaneous heparin in the preoperative period, and no postoperative chemical prophylaxis was administered. Group II patients received 40 mg subcutaneous enoxaparin in the immediate preoperative period, then once daily for 7 days postoperatively. A total of 195 patients were included in the study, 66 in Group I and 129 in Group II. The groups demonstrated statistically similar VTE risk profiles, based on the 2005 Caprini risk-assessment model. There were no statistically significant differences in the 2 primary outcomes: postoperative bleeding and VTE events. Group I patients had higher reoperation rates (22.7% vs 10.1%, P = 0.029), which was secondary to higher rates of revision procedures. A 7-day postoperative course of once-daily enoxaparin for VTE risk reduction in abdominal body contouring surgery does not significantly increase the risk of bleeding. Implementation of this regimen for postdischarge chemoprophylaxis, when indicated following individualized risk stratification, is appropriate.

1757 Applicability of Two Venous Thromboembolism Risk Assessment Models in Gynecologic Surgical Patients

Study Objective The aim of this study was to examine the applicability of the Caprini risk assessment model and gynecologic Caprini risk assessment model for postoperative venous thromboembolism risk assessment in gynecologic surgical patients and make a comparison between the two risk assessment models. Design A database of a randomized controlled trial was employed. Scores of Caprini and gynecologic Caprini risk assessment model were calculated for each patient. Patients were categorized into four risk level groups according to scores of risk assessment models. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results A total of 800 patients were included. The overall incidence of venous thromboembolism was 5.8%. By Caprini risk assessment model, no patient was at very low risk, 4.3% were at low risk, 44.4% were at moderate risk, and 51.4% were at high risk. The venous thromboembolism incidence of the low, moderate, and high risk group were 2.9%, 2.3%, and 9.0%, respectively. Spearman's rank correlation coefficient was 0.500 (p=0.667). 98.5% of patients with the malignant disease were categorized into the highest risk group. By gynecologic Caprini risk assessment model, 7.8% of the patients were at low risk, 28.0% were at moderate risk, 32.0% were at high risk, and 32.3% were at very high risk. The venous thromboembolism incidence of the low, moderate, high, and very high risk group was 0.0%, 1.2%, 5.1%, and 11.6%, respectively. Spearman's rank correlation coefficient was 1.000 (p Conclusion Gynecologic Caprini risk assessment model was suitable for venous thromboembolism risk assessment for gynecologic surgical patients. Current Caprini risk assessment model could not be applied to gynecologic surgical patients.

Performance of Risk Assessment Models for Peripartum Thromboprophylaxis

There is no consensus on which risk stratification approach to use for thromboprophylaxis in pregnancy, and most available risk assessment models (RAMs) for venous thromboembolism (VTE) events have not been validated in pregnancy. Our objective was to compare the performance of some of the most commonly used VTEs RAMs in our patient population in the peripartum period. This is a retrospective cohort of women who delivered at our institution in 2015 and 2016. We excluded patients with history of prior or current VTEs or those already receiving anticoagulants. Antepartum, intrapartum, and postpartum records were reviewed. Data were collected on known risk factors for VTEs in order to calculate scores for 3 RAMs on admission for delivery: Padua, Caprini, and Royal College of Obstetricians and Gynaecologists (RCOG). The primary objective was to the estimate the performance of the various RAMs in preventing postpartum VTEs. We calculated the proportion of women who would have been high risk, determined the number of VTEs cases within high- and low-risk categories, as well as calculated the number needed to treat (NNT) for each RAM. We performed analyses using different RAM scores cutoffs, VTEs outcome rates, and effectiveness of anticoagulation to prevent VTEs. The P value <.05 was considered statistically significant. A total of 6094 women were included. Three women had VTEs for an overall rate of 0.04% (N = 3; 95% confidence interval [CI]: 0.01-0.15). The proportion of women categorized as high risk for VTEs were 62% (95% CI: 61-64) for RCOG, 0.8% (95% CI: 0.6-1.0) for Padua, and 94% (95% CI: 94-95) for Caprini. Of the 3 VTEs, the RCOG model classified 1 woman as high risk and Padua model classified 3 women as high risk; whereas the Caprini did not identify any women as high risk. Assuming 100% effectiveness of thromboprophylaxis, the observed NNT was 3838 using RCOG, not able to calculate using Padua (no VTEs cases occurred in the high-risk group, thus none were prevented), and 1927 using Caprini. The rates of VTEs in pregnancy are very low and the available RAMs do not identify most of them. The RCOG and Caprini RAMs would categorize a large proportion of women as high risk and are associated with high NNTs. The Padua RAM appears to have the lowest NNT but missed all the VTEs in our cohort.

Determination of Risk Factors for Venous Thromboembolism by an Adapted Caprini Scoring System in Surgical Patients.

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3–4, 4.83 times for a Caprini score of 5–6, 8.84 times for a score of 7–8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all p values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.

Application of nursing interventions based on Caprini risk assessment model in prevention of deep venous thrombosis after stroke

Application of nursing interventions based on Caprini risk assessment model in prevention of deep venous thrombosis after stroke

A novel risk assessment model for venous thromboembolism after major thoracic surgery: a Chinese single-center study.

Venous thromboembolism (VTE) is an insidious disease with significant morbidity and mortality. We conducted a retrospective single-center study on patients who underwent thoracic surgery and developed a novel VTE risk assessment model (RAM). Patients who underwent thoracic surgery between July 2016 and December 2017 (n=533) at the Beijing Chao-Yang Hospital were enrolled in this study. None of the patients received any prophylaxis perioperatively. Lower limbs Doppler ultrasonography was performed before and after surgery for deep venous thrombosis (DVT) confirmation. Patients with new postoperative DVT, typical symptoms of pulmonary embolism (PE), or high Caprini score (≥9) underwent further computer tomography pulmonary angiography (CTPA) examination for PE. Caprini, Rogers, Padua, and Khorana RAM were used for all of the patients. A novel RAM of VTE, which we called Chao-Yang VTE RAM, was developed according to the logistic regression analysis. The overall incidence of VTE after thoracic surgery was 8.4% (45 of 533). Among the 45 VTE patients, 86.7% have DVT and 13.3% have DVT + PE. Age ≥60 (OR 4.51, 95% CI: 2.09-9.71, P=0.000) has an independent risk factor for VTE. The areas under the receiver operating characteristic (ROC) curve of Caprini, Rogers, Padua, Khorana, and Chao-Yang models were 0.74 (P<0.0001), 0.52 (P=0.62), 0.69 (P<0.0001), 0.64 (P=0.0017), and 0.80 (P<0.0001), respectively. The VTE incidence in the low-, moderate-, and high-risk groups predicted with Chao-Yang scores was 1.3% (3 of 230), 8.4% (14 of 166), and 20.4% (28 of 137); these were 1.6% (3 of 192), 11.9% (38 of 318), and 17.4% (4 of 23), respectively, when using the Caprini criteria. The high-risk group had a significantly higher incidence than the low- and moderate-risk groups (P=0.000). Additionally, as the number of risk factors increased, the incidence of VTE increased from 1.2% to 50.0%. The incidence of VTE in patients who underwent major thoracic surgery was high in our series. Based on a retrospective single-center population study, we developed a novel prediction model to identify patients receiving thoracic surgery with different risks for VTE events.

Postoperative Venous Thromboembolism after Extracranial Otologic Surgery.

To determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing otologic surgery. Cross-sectional retrospective study. Single tertiary academic center. Adults undergoing nononcologic, extracranial otologic surgery from August 2009 to December 2016. Patients with postoperative diagnosis VTE codes were identified. Imaging and clinical documents were searched for VTE evidence within the first 30 postoperative days. Methods of thromboprophylaxis were documented, and Caprini risk scores were calculated. In total, 1213 otologic surgeries were evaluated. No postoperative VTE events were identified (0/1268). Mean age was 51.0 ± 17.3 years (range, 18.1-93.4 years). Average length of surgery was 136.0 ± 79.0 minutes (range, 5-768 minutes). The average Caprini score in all patients was 4.0 ± 1.7 (range, 1-15). Eighty-five percent of patients had a Caprini score ≥3, the threshold at which chemoprophylaxis has been recommended in general surgery patients by the American College of Chest Physicians 2012 guidelines. Six patients had documented preoperative chemoprophylaxis and a Caprini score of 4.8 ± 1.7. This was not significantly different from that of patients who did not receive preoperative chemoprophylaxis (t test, P = .3). The literature would estimate a rate of 3.7% VTE in adults with similar Caprini scores undergoing general surgery procedures with no VTE prophylaxis. The Caprini risk assessment model may overestimate VTE risk in patients undergoing extracranial otologic surgery. Postoperative VTE following otologic surgery is rare, even in patients traditionally considered moderate or high risk. Chemoprophylaxis guidelines in this group should be balanced against the potential risk of increased intraoperative bleeding and its associated effects on surgical visualization and morbidity.

86 Incidence and Patient Characteristics for the Development of Venous Thromboembolic Events within the Adult Burn Center Population and an Evaluation of the Caprini Risk Assessment Model

86 Incidence and Patient Characteristics for the Development of Venous Thromboembolic Events within the Adult Burn Center Population and an Evaluation of the Caprini Risk Assessment Model

Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa.

Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

Forecasting effect of Caprini risk assessment model for venous thromboembolism on venous thromboembolism among surgery patients: a Meta analysis

Objective To comprehensively review the forecasting effect of Caprini risk assessment model for venous thromboembolism (VTE) on VTE among surgery patients with the method of Meta analysis. Methods We retrieved the articles on the forecasting Caprini risk assessment model for VTE on VTE in the Cochrance Library, PubMed, Web of Science, EMBASE, China Biology Medicine, China National Knowledge Infrastructure (CNKI) , WanFang data, Vip Database (VIP) published from establishing database to 31st December 2017. The diagnostic studies quality evaluation instrument was used to assess the quality of the included articles and the data were analyzed with the Meta-Disc 1.4 software and Stata software. Results A total of 7 articles were included (n=1 520) . Heterogeneity test showed that there was heterogenicity in the included researches with 0.85 (95% CI: 0.79-0.90) for the combined sensibility by random effect model, 0.58 (95% CI: 0.55-0.61) for the specificity, 2.16 (95% CI: 1.76-2.65) for the positive likelihood ratio, 0.18 (95% CI: 0.07-0.48) for the negative likelihood ratio and 12.06 (95% CI: 4.76-30.56) . The area under the curve of summary receive opearating characteristic curve (SROC) was 0.748 with no publication bias. Conclusions The Caprini risk assessment model for VTE is a single indicator for the forecasting effect of the VTE of patients with surgery along with a high predictive sensibility and a strong overall diagnostic efficiency. It can effectively screen patients with the risk of venous thrombosis with a diagnostic value and low specificity. We should carry out many perspective studies and establish a suitable critical value aiming at scales in the future. Key words: Meta-analysis; Venous thromboembolism; Caprini risk assessment model for venous thromboembolism; Forecasting; Systematic review

Completion of the Updated Caprini Risk Assessment Model (2013 Version).

The Caprini risk assessment model (RAM) has been validated in over 250 000 patients in more than 100 clinical trials worldwide. Ultimately, appropriate treatment options are dependent on precise completion of the Caprini RAM. As the numerical score increases, the clinical venous thromboembolism rate rises exponentially in every patient group where it has been properly tested. The 2013 Caprini RAM was completed by specially trained medical students via review of the presurgical assessment history, medical clearances, and medical consults. The Caprini RAM was completed for every participant both preoperatively and predischarge to ensure that any changes in the patient’s postoperative course were captured by the tool. This process led to the development of completion guidelines to ensure consistency and accuracy of scoring. The 2013 Caprini scoring system provides a consistent, thorough, and efficacious method for risk stratification and selection of prophylaxis for the prevention of venous thrombosis.

Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis.

Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk assessment. We compared the results of our prospective department protocol to the Caprini risk assessment model (RAM) retrospectively in this study group. Our goal was to determine whether the department protocol or the Caprini score would identify venous thromboembolism (VTE) events after total joint replacement. A secondary purpose was to validate the 2013 Caprini RAM in joint arthroplasty and determine whether patients with VTE would be accurately identified using the Caprini score. A total of 1078 patients met inclusion criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or less is considered low risk. The 2013 version of the Caprini RAM retrospectively stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the prospective department protocol. This tool provided a consistent, accurate, and efficacious method for risk stratification and selection of chemoprophylaxis.

The value of Caprini thrombosis risk assessment in postoperative patients with lung cancer

Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE). Methods A retrospective analysis of 136 patients with postoperative lung cancer who were admitted to our department between October 2015 and October 2017 was followed up for 2 months. According to the follow-up results, the patients were divided into VTE group and non-VTE group. The VTE group was further divided into the PE group and the deep venous thrombosis (DVT) group according to the embolization type. Comparisons were made between the two groups for general clinical data, surgically related parameters, and differences in Caprini scores. Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model. Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE. Results There were 39 cases in VTE group and 97 cases in non-VTE group. Among them, 28.2% (11/39) of VTE events occurred after discharge. The hospitalization time and Caprini risk scores in VTE group were (16.3±3.6) days, (10.5±2.4) points, which were significantly higher than (8.9±3.4) days, (9.3±2.1) points in non-VTE group (t=11.287, 2.891, P<0.01). In the VTE event, the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant. It was worse than DVT group (P<0.05). When Caprini's high-risk risk cut-off was 9 points, the accuracy was 76.5%, the positive predictive value was 58.1%, the negative predictive value was 84.9%, and the sensitivity and specificity were 64.1% and 81.4%, respectively. Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01), varices (P<0.01), sepsis (P<0.01), and severe acute lung disease (P<0.01). Congestive heart failure (P<0.01), central venous catheter (P<0.01), and VTE history (P<0.01) were all independent risk factors associated with VTE events. The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5 and 8.4 times higher than that in low-risk patients. Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer, and the use of 9 points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity. Key words: Lung neoplasms; Postoperative complicatlons; Venous thromboembolism; Caprini thrombosis risk assessment model

Application value of Caprini risk assessment model and elevated tumor-specific D-dimer level in predicting postoperative venous thromboembolism for patients undergoing surgery of gynecologic malignancies.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in gynecologic malignant patients after surgery. We aimed to validate the Caprini risk assessment model (RAM) and elevated tumor-specific D-dimer as predictive marker of postoperative VTE for patients undergoing surgery of gynecologic malignancies. Inpatients were divided into five groups (low: score = 0-1; moderate: score = 2; high: score = 3-4; higher: score = 5-7; sup-high: score > 7) and treated according to their risk level after the surgery during the hospitalization according to the Caprini RAM. D-dimer level was detected during the perioperative period. If D-dimer did not fall to normal reference range on the seventh day after operation, the use of low-molecular-weight heparin was prolonged to 28 days after surgery. The majority (853/974, 87.6%) of the patients was in the Caprini score ≥5, with an overall VTE incidence of 1.75%. The VTE group had significantly higher Caprini score, CA125, vascular invasion rate and lymph node metastasis rate. If 1.5 μg/mL was used as the D-dimer cut-off value to predicting VTE, the sensitivity was 87.5%, the specificity was 93.8% and the negative predictive value was 99.2%. The D-dimer level was a marker for prolonging the anticoagulants use during the perioperative period, especially for the sup-high group. The Caprini RAM is an effective and reliable VTE risk prediction tool for patients undergoing gynecological malignant tumor surgery. The group (score ≥ 5) can be divided into two subgroups (higher: score = 5-7 and sup-high: score > 7), which may better predict the occurrence of VTE for malignant tumor patients. Great than 1.5 μg/mL D-dimer before operation should be given more attention for the presence of VTE.

Assessment of the Risk of Venous Thromboembolism in Medical Inpatients using the Padua Prediction Score and Caprini Risk Assessment Model.

Aim: The optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in medical inpatients is not known. We examined and compared how well the Padua Prediction Score (PPS) and the Caprini RAM stratify VTE risk in medical inpatients.Methods: We undertook a retrospective case-control study among medical inpatients admitted to a large general hospital in China during a 4-year period. In total, 902 cases were confirmed to have VTE during hospitalization and 902 controls were selected randomly to match cases by medical service.Results: The VTE risk increased significantly with an increase of the cumulative PPS or Caprini RAM score. A PPS and Caprini RAM “high risk” classification was, respectively, associated with a 5.01-fold and 4.10-fold increased VTE risk. However, the Caprini RAM could identify 84.3% of the VTE cases to receive prophylaxis according to American College of Chest Physicians guidelines, whereas the PPS could only identify 49.1% of the VTE cases. In the medical inpatients studied, five risk factors seen more frequently in VTE cases than in controls in the Caprini RAM were not included in the PPS. The Caprini RAM risk levels were linked almost perfectly to in-hospital and 6-month mortality.Conclusions: Both the PPS and Caprini RAM can be used to stratify the VTE risk in medical inpatients effectively, but the Caprini RAM may be considered as the first choice in a general hospital because of its incorporation of comprehensive risk factors, higher sensitivity to identify patients who may benefit from prophylaxis, and potential for prediction of mortality.

Risk factors of early venous thromboembolism based on Caprini model among patients with thoracoscopic lobectomy for lung

Objective To explore the risk factors of early venous thromboembolism (VTE) based on Caprini risk assessment model among patients with thoracoscopic lobectomy for lung. Methods From June 2015 to December 2017, retrospective analysis was used to collect the data of 28 patients with pulmonary embolism one week after thoracoscopic lobectomy for lung of Shanghai Chest Hospital, Shanghai Jiaotong University, in observation group. And we selected 84 patients with the same operation in the same term by convenience sampling in control group according to the ratio of 1: 3. Patients of two groups were scored with the Caprini risk assessment model. Single factor analysis and Logistic regression analysis were used to the risk factors in Caprini risk assessment model and related factors of lung lobectomy. Results The Caprini score of patients group in observation group was higher than that in control group with a significant difference (P<0.01) . The proportion of moderate risk and high risk in patients with VTE was 78.6% in observation group and was 20.2% in control group with a statistical difference in the risk classification (P<0.01) . Logistic regression analysis took patients in case group as dependent variable and 16 risk factors in clinical baseline information as the independent variable showed the body mass index≥25 kg/m2, smoking history, preoperative plasma D-dimer higher than the critical value had positive correlations with the risk of VTE after surgery (OR=13.354, 5.639, 3.084; P<0.05) . Conclusions The Caprini risk assessment model can well determine the risk factors of VTE among patients with thoracoscopic lobectomy for lung. The high risk factors of VTE of these patients may include long-term and heavy smoking, overweight and preoperative plasma D-dimer higher than the critical value. Key words: Venous thrombosis; Pulmonary embolism; Risk factors; Thoracoscopes; Lung lobectomy; Caprini model

Comparison of a novel predictor of venous thromboembolic complications in inflammatory bowel disease with current predictors.

Venous thromboembolism (VTE) is a common complication of inflammatory bowel disease (IBD). The aim of the present study was to identify predictors of VTE in hospitalized patients with IBD. Patients with IBD who were hospitalized from February 2015 to March 2016 at the Chiba University Hospital were included. VTE was detected using enhanced computed tomography, and VTE onset within 2months after admission was assessed. Predictors of VTE onset were investigated with clinical factors during hospitalization. Availability of the Caprini risk assessment model and Padua prediction score at the time of admission was also assessed. Seventy-two patients with IBD were hospitalized, and central venous catheters were placed in 43 of the 72 patients. During the observation period, VTE occurred in six patients (8.3%); however, none died as a result of the condition. Cox proportional hazards regression analysis identified D-dimer values on admission as a risk factor that was highly associated with VTE onset (hazard ratio=1.590; 95% confidence interval, 1.132-2.233; P=0.007) and significantly predicted the occurrence of VTE using the receiver operating characteristic curve (P=0.005, area under the curve=0.893). However, Caprini risk assessment model and Padua prediction scores were not useful tools for predicting VTE onset in patients with IBD. In hospitalized patients with IBD, D-dimer values were highly associated with VTE onset. Therefore, measurement of D-dimer values on admission is critical for the management of thromboembolic complications in patients with IBD.

VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients’ Risk Profile for Venous Thromboembolism (DissolVE-2)—A Cross-sectional Study

Limited data exist on VTE risk and prophylaxis in Chinese inpatients. The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism-2 (DissolVE-2), a nationwide, multicenter, cross-sectional study, was therefore designed to investigate prevalence of VTE risks and evaluate VTE prophylaxis implementation compliant with the latest prophylaxis guidelines (American College of Chest Physicians [CHEST], 9th edition). Adults admitted (≥ 72 h) to 60 urban, tertiary Chinese hospitals due to acute medical conditions or surgery from March to September 2016 were assessed for VTE risk. Risk assessments were made by using the Padua Prediction Scoring or Caprini Risk Assessment model, risk factors, and prophylaxis based on the CHEST guidelines, 9th edition. A total of 13,609 patients (6,986 surgical and 6,623 medical) were analyzed. VTE risk in surgical inpatients was categorized as low (13.9%; 95% CI, 13.1-14.7), moderate (32.7%; 95% CI, 31.6-33.8), and high (53.4%; 95% CI, 52.2-54.6); risk in medical patients was categorized as low (63.4%; 95% CI, 62.2-64.6) and high (36.6%; 95% CI, 35.4-37.8). Major risk factors in surgical and medical patients were major open surgery (52.6%) and acute infection (42.2%), respectively. Overall rate of any prophylaxis and appropriate prophylactic method was 14.3%(19.0%vs9.3%) and 10.3%(11.8%vs6.0%) in surgical and medical patients. A large proportion of hospitalized patients reported VTE risk and low rate of CHEST-recommended prophylaxis. The data highlight the insufficient management of VTE risk and show the great potential for improving physicians' awareness and current practices across China. Chinese Clinical Trial Registry; No.: ChiCTR-OOC-16010187; URL: http://www.chictr.org.cn/showproj.aspx?proj=17077.

Prevalence of venous thromboembolism after lung surgery in China: a single-centre, prospective cohort study involving patients undergoing lung resections without perioperative venous thromboembolism prophylaxis†.

Venous thromboembolism (VTE) is a common postoperative complication. Previous studies have shown that the incidence of VTE after major thoracic surgery ranges from 2.3% to 15%. However, there have been no such data from China so far. To evaluate the incidence of postoperative VTE, we conducted a single-centre, prospective cohort study. Patients who underwent lung resections between July 2016 and March 2017 were enrolled in this study. None of the patients received any prophylaxis perioperatively. All patients were screened for deep venous thrombosis (DVT) using non-invasive duplex lower-extremity ultrasonography 30 days before surgery and within 30 days after surgery and before discharge. Chest tomography, pulmonary embolism protocol was carried out if patients had one of the following conditions: (i) typical symptoms of pulmonary embolism, (ii) high Caprini score (≥9 points) and (iii) newly diagnosed postoperative DVT. Two hundred and sixty-two patients undergoing lung surgery were enrolled, including 115 benign and 147 malignant disease cases. The procedures included 84 sublobar lung resections, 161 lobectomies, 5 pneumonectomies and 12 mixed procedures. The overall postoperative incidence of VTE was 11.5% (30 of 262). Twenty-four patients were diagnosed with DVT (80.0%) and 6 with DVT + pulmonary embolism (20.0%). None of the patients diagnosed with VTE had obvious symptoms of VTE. The median time for VTE detection was 5 days postoperatively. The incidence of VTE was 7.0% in patients with benign lung diseases and 15.0% in those with malignant lung diseases (P < 0.05). Using the Caprini risk assessment model, 63 cases were scored as low risk, 179 as moderate risk and 20 as high risk, and each group had an incidence of postoperative VTE of 0%, 12.3% (22 of 179) and 40.0% (8 of 20), respectively (P < 0.05). In patients with lung cancer, 98% were moderate or high risk, and only 3 patients were scored in the low risk category. The incidence of VTE in patients at moderate risk and high risk was 12.0% and 36.8%, respectively, while it was 0 in low-risk patients. The following conclusions were drawn: (i) the overall incidence of postoperative VTE after lung surgery without VTE prophylaxis is substantial; (ii) lower-extremity ultrasonography was helpful in detecting asymptomatic DVT in symptomatic or high-risk patients; and (iii) VTE prophylaxis should be considered as a mandatory part of perioperative care. ChiCTR-EOC-17010577.

Stratification of venous thromboembolism risk in burn patients by Caprini score

BackgroundThe purpose of the research was to determine the efficacy of the Caprini risk assessment model for the guidance of prophylactic treatments for a 3-year period in the burn center of the Inner Mongolia region. MethodsFrom July 2014 to August 2017, the Caprini score for every admitted patient was calculated to evaluate venous thromboembolism (VTE) risk. Subjects with a Caprini score between 0 and 2 were not administered a chemical VTE prophylaxis, and subjects with a score of 3 and above were administered low-molecular-weight heparin (LMWH). Demographic information, abbreviated burn severity index (ABSI) score, body mass index (BMI), Caprini score, full-thickness total body surface area (TBSA), overall TBSA, day of ambulation, hospital stay, inhalation injury, electrical burn, central venous catheters, and operations were noted for analysis. ResultsOf 1939 inpatients during the study period, 13 patients (0.67%) had VTE complications. The interval from injury to VTE diagnosis was 13.9±8.7 days. Among patients (n=1131) with a Caprini score between 0 and 2, two patients (0.18%) had VTE. A total of 792 patients received LMWH thromboprophylaxis; 11 patients had VTE complications, and among them, one patient (0.13%) developed heparin-induced thrombocytopenia and two patients (0.25%) developed major bleeding. VTE (8.82%) occurred most commonly in the Caprini score >8 group. Age, Caprini score, ABSI score, overall and full-thickness TBSA, central venous catheters, day of ambulation, and hospital stay in patients with VTE (n=11) were significantly higher than those (n=781) without VTE (p<0.05). ConclusionsCaprini score allows for informed decision-making regarding prophylaxis strategies. Early ambulation and mechanical prophylaxis are recommended for patients predisposed to VTE.