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CC BY-NC-ND 4.0 · Thromb Haemost 2024; 124(03): 223-235
DOI: 10.1055/a-2122-7780
Stroke, Systemic or Venous Thromboembolism

The Validation and Modification of the Caprini Risk Assessment Model for Evaluating Venous Thromboembolism after Joint Arthroplasty

Liang Qiao   *
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
2   Department of Orthopedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Yao Yao   *
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Dengxian Wu
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Ruijuan Xu
5   Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
,
Honggang Cai
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Ying Shen
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Zhihong Xu
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
,
Qing Jiang
1   Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, PR China
3   State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing, Jiangsu, PR China
4   Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, Jiangsu, PR China
› Institutsangaben Funding This work was supported by the Key Program of National Natural Science Foundation of China (81730067), the Major Project of National Natural Science Foundation of China (81991514), the National Natural Science Foundation of China (81871832), Life and Health Science and Technology Special Project—Medical-Industrial Cooperation Project of Nanjing (202110026), and Clinical Trials from the Affiliated Drum Tower Hospital, Medical School of Nanjing University (2022-LCYJ-DBZ-01).
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Ein Kommentar zu:

A New Chapter Regarding Thrombosis Risk Assessment in Total Joint Replacement PatientsThromb Haemost 2024; 124(03): 236-238
DOI: 10.1055/a-2174-0963

Abstract

Background The Caprini risk assessment model (RAM) is the most commonly used tool for evaluating venous thromboembolism (VTE) risk, a high score for arthroplasty can result in patients being classified as high risk for VTE. Therefore, its value in post-arthroplasty has been subject to debate.

Methods Retrospective data were collected from patients who underwent arthroplasty between August 2015 and December 2021. The study cohort included 3,807 patients, all of whom underwent a thorough evaluation using Caprini RAM and vascular Doppler ultrasonography preoperatively.

Results A total of 432 individuals (11.35%) developed VTE, while 3,375 did not. Furthermore, 32 (0.84%) presented with symptomatic VTE, while 400 (10.51%) were detected as asymptomatic. Additionally, 368 (9.67%) VTE events occurred during the hospitalization period, and 64 (1.68%) cases were detected during postdischarge follow-up. Statistical analysis revealed significant differences between the VTE and non-VTE groups in terms of ages, blood loss, D-dimer, body mass index >25, visible varicose veins, swollen legs, smoking, history of blood clots, broken hip, percent of female, hypertension, and knee joint arthroplasty (p < 0.05). The Caprini score was found to be significantly higher in the VTE group (10.10 ± 2.23) compared with the non-VTE group (9.35 ± 2.14) (p < 0.001). Furthermore, there was a significant correlation between the incidence of VTE and the Caprini score (r = 0.775, p = 0.003). Patients with a score ≥9 are at a high-risk threshold for postoperative VTE.

Conclusion The Caprini RAM shows a significant correlation with the occurrence of VTE. A higher score indicates a greater likelihood of developing VTE. The score ≥9 is at particularly high risk of developing VTE.

Keywords

Caprini risk assessment model (RAM) - venous thromboembolism (VTE) - arthroplasty

* These authors contributed equally to this study.




Publikationsverlauf

Eingereicht: 18. April 2023

Angenommen: 27. Juni 2023

Accepted Manuscript online:
04. Juli 2023

Artikel online veröffentlicht:
02. August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Lachiewicz PF. New concepts in orthopaedic thromboprophylaxis. J Bone Joint Surg Br 2005; 87 (06) 885-886 , author reply 886
    CrossrefPubMedSuche in Google Scholar
  • 2 Liu J, Zhao J, Yan Y, Su J. Effectiveness and safety of rivaroxaban for the prevention of thrombosis following total hip or knee replacement: a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98 (09) e14539
    CrossrefPubMedSuche in Google Scholar
  • 3 Lippi G, Favaloro EJ, Cervellin G. Prevention of venous thromboembolism: focus on mechanical prophylaxis. Semin Thromb Hemost 2011; 37 (03) 237-251
    Thieme ConnectPubMedSuche in Google Scholar
  • 4 Pierce TP, Cherian JJ, Jauregui JJ, Elmallah RK, Lieberman JR, Mont MA. A current review of mechanical compression and its role in venous thromboembolic prophylaxis in total knee and total hip arthroplasty. J Arthroplasty 2015; 30 (12) 2279-2284
    CrossrefPubMedSuche in Google Scholar
  • 5 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6, Suppl): 381S-453S
    CrossrefPubMedSuche in Google Scholar
  • 6 Lee WS, Kim KI, Lee HJ, Kyung HS, Seo SS. The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis. Clin Orthop Relat Res 2013; 471 (05) 1523-1532
    CrossrefPubMedSuche in Google Scholar
  • 7 Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med 2010; 16 (05) 448-452
    CrossrefPubMedSuche in Google Scholar
  • 8 Wells PS, Anderson DR, Rodger M. et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83 (03) 416-420
    Thieme ConnectPubMedSuche in Google Scholar
  • 9 Le Gal G, Righini M, Roy PM. et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006; 144 (03) 165-171
    CrossrefPubMedSuche in Google Scholar
  • 10 Barbar S, Noventa F, Rossetto V. et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 8 (11) 2450-2457
    CrossrefPubMedSuche in Google Scholar
  • 11 Chopra V, Kaatz S, Conlon A. et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost 2017; 15 (10) 1951-1962
    CrossrefPubMedSuche in Google Scholar
  • 12 Yue J, Zhang Y, Xu F. et al. A clinical study of peripherally inserted central catheter-related venous thromboembolism in patients with hematological malignancies. Sci Rep 2022; 12 (01) 9871
    CrossrefPubMedSuche in Google Scholar
  • 13 Klen J, Horvat G, Blinc A. Perioperative prevention of venous thromboembolism in abdominal surgery patients based on the Caprini or the Padua Risk Score-a single centre prospective observational study. Life (Basel) 2022; 12 (11) 1843
    PubMedSuche in Google Scholar
  • 14 Osteology CSo. Prevention of venous thromboembolism after major orthopaedic surgery. Zhonghua Guke Zazhi 2016; 36 (02) 65-71
    PubMedSuche in Google Scholar
  • 15 Ore AS, Vigna C, Fabrizio A, Cataldo TE, Messaris E, Crowell K. Are IBD patients underscored when determining postoperative VTE risk?. J Gastrointest Surg 2023; 27 (02) 347-353
    CrossrefPubMedSuche in Google Scholar
  • 16 He CQ, Sun HY, Feng GQ, Li HF, Yuan DL. The prevention of venous thromboembolism after gynecological surgery with nursing intervention based on the G-Caprini Scale. Int J Womens Health 2022; 14: 1547-1553
    CrossrefPubMedSuche in Google Scholar
  • 17 Dong H, Liang X, Gao Y. et al. Postoperative venous thromboembolism after surgery for stage IA non-small-cell lung cancer: a single-center, prospective cohort study. Thorac Cancer 2022; 13 (09) 1258-1266
    CrossrefPubMedSuche in Google Scholar
  • 18 Arcelus JI, Candocia S, Traverso CI, Fabrega F, Caprini JA, Hasty JH. Venous thromboembolism prophylaxis and risk assessment in medical patients. Semin Thromb Hemost 1991; 17 (Suppl 3): 313-318
    PubMedSuche in Google Scholar
  • 19 Wang H, Lv B, Li W, Wang S, Ding W. Diagnostic performance of the Caprini Risk Assessment Model combined with D-dimer for preoperative deep vein thrombosis in patients with thoracolumbar fractures caused by high-energy injuries. World Neurosurg 2022; 157: e410-e416
    CrossrefPubMedSuche in Google Scholar
  • 20 Cronin M, Dengler N, Krauss ES. et al. Completion of the updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost 2019; 25: 1076029619838052
    CrossrefPubMedSuche in Google Scholar
  • 21 Krauss ES, Segal A, Dengler N, Cronin M, Pettigrew J, Simonson BG. Utilization of the Caprini score for risk stratification of the arthroplasty patient in the prevention of postoperative venous thrombosis. Semin Thromb Hemost 2022; 48 (04) 407-412
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 Krauss ES, Cronin M, Dengler N, Simonson BG, Enker P, Segal A. Lessons learned: using the Caprini Risk Assessment Model to provide safe and efficacious thromboprophylaxis following hip and knee arthroplasty. Clin Appl Thromb Hemost 2020; 26: 1076029620961450
    CrossrefPubMedSuche in Google Scholar
  • 23 Krauss ES, Segal A, Cronin M. et al. Implementation and validation of the 2013 Caprini score for risk stratification of arthroplasty patients in the prevention of venous thrombosis. Clin Appl Thromb Hemost 2019; 25: 1076029619838066
    CrossrefPubMedSuche in Google Scholar
  • 24 Bateman DK, Dow RW, Brzezinski A, Bar-Eli HY, Kayiaros ST. Response to the Letter to the Editor on “Correlation of the Caprini Score and venous thromboembolism incidence following primary total joint arthroplasty-results of a single-institution protocol”. J Arthroplasty 2018; 33 (08) 2698-2699
    CrossrefPubMedSuche in Google Scholar
  • 25 Wilson S, Chen X, Cronin M. et al. Thrombosis prophylaxis in surgical patients using the Caprini Risk Score. Curr Probl Surg 2022; 59 (11) 101221
    CrossrefPubMedSuche in Google Scholar
  • 26 Pannucci CJ, Fleming KI. Comparison of face-to-face interaction and the electronic medical record for venous thromboembolism risk stratification using the 2005 Caprini score. J Vasc Surg Venous Lymphat Disord 2018; 6 (03) 304-311
    CrossrefPubMedSuche in Google Scholar
  • 27 Wainwright TW, Gill M, McDonald DA. et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop 2020; 91 (01) 3-19
    CrossrefPubMedSuche in Google Scholar
  • 28 Falck-Ytter Y, Francis CW, Johanson NA. et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e278S-e325S
    CrossrefPubMedSuche in Google Scholar
  • 29 Obi AT, Pannucci CJ, Nackashi A. et al. Validation of the Caprini venous thromboembolism risk assessment model in critically ill surgical patients. JAMA Surg 2015; 150 (10) 941-948
    CrossrefPubMedSuche in Google Scholar
  • 30 Bateman DK, Dow RW, Brzezinski A, Bar-Eli HY, Kayiaros ST. Correlation of the Caprini score and venous thromboembolism incidence following primary total joint arthroplasty-results of a single-institution protocol. J Arthroplasty 2017; 32 (12) 3735-3741
    CrossrefPubMedSuche in Google Scholar
  • 31 Zeng Y, Shen B, Yang J, Zhou Z, Kang P, Pei F. Preoperative comorbidities as potential risk factors for venous thromboembolism after joint arthroplasty: a systematic review and meta-analysis of cohort and case-control studies. J Arthroplasty 2014; 29 (12) 2430-2438
    CrossrefPubMedSuche in Google Scholar
  • 32 Boureau AS, de Decker L. Blood transfusion in older patients. Transfus Clin Biol 2019; 26 (03) 160-163
    CrossrefPubMedSuche in Google Scholar
  • 33 Cheng YJ, Liu ZH, Yao FJ. et al. Current and former smoking and risk for venous thromboembolism: a systematic review and meta-analysis. PLoS Med 2013; 10 (09) e1001515
    CrossrefPubMedSuche in Google Scholar
  • 34 Lu Y, Zhou Z-Y, Liu Y-K, Chen H-L, Yang H-L, Liu F. Gender differences of venous thromboembolism risk after total hip and total knee arthroplasty: a meta-analysis. J Thromb Thrombolysis 2016; 41 (04) 556-562
    CrossrefPubMedSuche in Google Scholar
  • 35 Bohl DD, Maltenfort MG, Huang R, Parvizi J, Lieberman JR, Della Valle CJ. Development and validation of a risk stratification system for pulmonary embolism after elective primary total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 187-191
    CrossrefPubMedSuche in Google Scholar
  • 36 Hanh BM, Cuong LQ, Son NT. et al. Determination of risk factors for venous thromboembolism by an adapted Caprini scoring system in surgical patients. J Pers Med 2019; 9 (03) 36
    CrossrefPubMedSuche in Google Scholar
  • 37 Singjie LC, Halomoan R, Saleh I, Sumargono E, Kholinne E. Clinical effectiveness and safety of aspirin and other anticoagulants for venous thromboembolism prophylaxis after major orthopedic surgery: a systematic review and meta-analysis of randomized clinical trials. EFORT Open Rev 2022; 7 (12) 792-799
    CrossrefPubMedSuche in Google Scholar
  • 38 Nimeri AA, Bautista J, Ibrahim M. et al. Mandatory risk assessment reduces venous thromboembolism in bariatric surgery patients. Obes Surg 2018; 28 (02) 541-547
    CrossrefPubMedSuche in Google Scholar
  • 39 Jeong HS, Miller TJ, Davis K. et al. Application of the Caprini risk assessment model in evaluation of non-venous thromboembolism complications in plastic and reconstructive surgery patients. Aesthet Surg J 2014; 34 (01) 87-95
    CrossrefPubMedSuche in Google Scholar