This Caprini score for DVT calculator stratifies risk for deep vein thrombosis and subsequent complications in surgery patients based on risk factors. There are instructions on how to use the risk assessment and some guidelines of DVT in the text below the form.
How does the Caprini score for DVT calculator work?
This health tool is based on the Venous Thromboembolism Risk Factor Assessment that predicts risk for deep vein thrombosis DVT and helps in the management of prophylaxis.
There are several variables taken in consideration (accounting for 20 separate risk factors), each put in one of the five categories, based on the weight in the final score.
The original score is derived from a prospective study of 538 general surgery patients. The assessor or the subject completing the Caprini score calculator is asked to select any of the stated that apply from the following:
Risk factors adding 1 point each:
■ Age 41-60 years;
■ Minor surgery planned;
■ History of prior major surgery;
■ Varicose veins;
■ History of inflammatory bowel disease;
■ Swollen legs (current);
■ Obesity (BMI >30);
■ Acute myocardial infarction (<1 month);
■ Congestive heart failure (<1 month);
■ Sepsis (<1 month);
■ Serious lung disease incl. pneumonia (<1 month);
■ Abnormal pulmonary function (COPD);
■ Medical patient currently at bed rest;
■ Leg plaster cast or brace;
■ Other risk factors.
Risk factors adding 2 points each:
■ Age 60-74 years;
■ Major surgery (>60 minutes);
■ Arthroscopic surgery (>60 minutes);
■ Laparoscopic surgery (>60 minutes);
■ Previous malignancy;
■ Central venous access;
■ Morbid obesity (BMI >40).
Risk factors adding 3 points each:
■ Age over 75 years;
■ Major surgery lasting 2-3 hours;
■ BMI >50 (venous stasis syndrome);
■ History of SVT, DVT/PE;
■ Family history of DVT/PE;
■ Present cancer or chemotherapy;
■ Positive Factor V Leiden;
■ Positive Prothrombin 20210A;
■ Elevated serum homocysteine;
■ Positive Lupus anticoagulant;
■ Elevated anticardiolipin antibodies;
■ Heparin-induced thrombocytopenia (HIT);
■ Other thrombophilia.
Risk factors adding 5 points each:
■ Elective major lower extremity arthroplasty;
■ Hip, pelvis or leg fracture (<1 month);
■ Stroke (<1 month);
■ Multiple trauma (<1 month);
■ Acute spinal cord injury (paralysis) (<1 month);
■ Major surgery lasting over 3 hours.
Risk factors for women, adding 1 point each:
■ Oral contraceptives or hormone replacement therapy;
■ Pregnancy or postpartum (<1 month);
■ History of unexplained stillborn infant, recurrent spontaneous abortion (≥3), premature birth with toxemia or growth-restricted infant.
In some patients, the presence of factors associated with increased bleeding needs to be considered before anticoagulant therapy or sequential compression devices:
■ Active bleed;
■ Platelet count less than 100,000/ mm3;
■ Ingestion of oral anticoagulants;
■ History of heparin induced thrombocytopenia;
■ Abnormal creatinine clearance values.
Caprini score interpretation
This risk assessment aims to review personal history and current health factors that may be associated with the apparition of DVT. After the score is calculated, medical professionals can use it to devise a prophylaxis plan against any blood clots. The risk increases with the presence of more risk factors.
| Total Risk Factor score | Risk level | DVT incidence | Prophylaxis regimen* |
| 0 - 1 | Low | <10% | No specific measures; early ambulation |
| 2 | Moderate | 10 - 20% | ES, IPC, LDUH (5000U BID), or LWMH (<3400 U) |
| 3 - 4 | High | 20 - 40% | IPC, LDUH (5000U TID), or LMWH (>3400U) |
| ≥5 | Highest | 40 - 80% with 1 - 5% mortality | Pharmacological: LDUH, LMWH (>3400 U), Warfarin, or FXa I alone or in combination with ES or IP |
*Where:
ES – elastic stockings
IPC – intermittent pneumatic compression
LDUH – low dose unfractionated Heparin
LMWH – low molecular weight Heparin
FXa I – Factor X inhibitor
The validation result of the Caprini score states that it effectively risk-stratifies plastic and reconstructive surgery patients for venous thromboembolism risk. Another validation study has studied VTE events over a period of 30 days in urology and vascular surgery patients.
Deep Venous Thrombosis guidelines
DVT and the development of venous thromboembolism are common complications following major surgery. The risk of VTE being of up to 30% in some surgical patients.
The primary complication of the blood clots, forming in the large veins and then migrating in the circulatory system, is the occurrence of a pulmonary embolism.
PEs are complex conditions and require immediate medical assistance but at the same time can easily be prevented in patients who are already diagnosed with DVT.
Causes of DVT include most of the above discussed risk factors along with genetic predisposition and immobility during long time travel.
The main signs of DVT include swollen and painful legs, tenderness, redness or discoloration of the skin. However, in some cases, none of the above are present and the diagnosis can be difficult before the blood clot treatment can begin.
One of the clinical prediction rules for deep venous thromboembolisms is the Wells score which categorizes the likelihood of DVT and issues a recommendation for ultrasound diagnosis if necessary.
Some of the DVT prophylaxis methods include:
■ Compression stockings (GCS);
■ Intermittent pneumatic compression (IPC) devices;
■ Unfractionated heparin;
■ Low-molecular-weight heparin.
References
1) Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. (1991) Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost; 17 Suppl 3:304-12.
2) Caprini JA. (2005) Thrombosis risk assessment as a guide to quality patient care. Dis Mon; 51(2-3):70-8.
3) Caprini JA. (2010) Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. The American Journal of Surgery; (199)1 S3-S10.
4) Pannucci CJ, Bailey SH, Dreszer G, Fisher C, Zumsteg JW, Jabper RM, BS, Hamill JB, Hume KM, Rubin JP, MD, Neligan PC, Kallianen LK, Hoxworth RD, Pusic AL, Wilkins EG. (2011) Validation of the Caprini Risk Assessment Model in Plastic and Reconstructive Surgery Patients. J Am Coll Surg; 212(1): 105–112.
5) Liu X, Liu C, Chen X, Wu W, Lu G. (2016) Comparison between Caprini and Padua risk assessment models for hospitalized medical patients at risk for venous thromboembolism: a retrospective study. Interact Cardiovasc Thorac Surg; 23(4):538-43.
6) Goldhaber SZ, Bounameaux H. (2012) Pulmonary embolism and deep vein thrombosis. Lancet; 379(9828):1835-46.
7) Laryea J, Champagne B. (2013) Venous thromboembolism prophylaxis. Clin Colon Rectal Surg; 26(3):153-9.
09 Oct, 2016