Scoring Systems for Estimating Risk of Venous Thromboembolism in Surgical Patients

Abstract

Venous thromboembolism (VTE) is one of the most common and feared complications in surgical patients, and its prevention has been the subject of a Call to Action from the Surgeon General of the United States. Here, we review the literature on the use of risk assessment models for the stratification of surgical patients into risk groups to guide the administration of pharmacoprophylaxis. Despite some disagreement in the literature and among various guidelines, there is good evidence that risk stratification identifies a 7- to 20-fold variation in postoperative VTE risk among the overall surgical population, including patients at both low and high risk. This information is useful to providers who are making decisions about mechanical prophylaxis and pharmacoprophylaxis.

Keywords

venous thromboembolism - deep vein thrombosis - pulmonary embolism - risk assessment models - Caprini score - hospital quality

• References

• 1 Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331 (24) 1601-1606
• 2 Agnelli G, Bolis G, Capussotti L. , et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 2006; 243 (01) 89-95
• 3 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (06) 809-815
• 4 Sweetland S, Green J, Liu B. , et al; Million Women Study collaborators. Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ 2009; 339: b4583
• 5 Anderson Jr FA, Zayaruzny M, Heit JA, Fidan D, Cohen AT. Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol 2007; 82 (09) 777-782
• 6 Rathbun S. Cardiology patient pages. The Surgeon General's call to action to prevent deep vein thrombosis and pulmonary embolism. Circulation 2009; 119 (15) e480-e482
• 7 Nimeri AA, Gamaleldin MM, McKenna KL, Turrin NP, Mustafa BO. Reduction of venous thromboembolism in surgical patients using a mandatory risk-scoring system: 5-Year follow-up of an American College of Surgeons National Surgical Quality Improvement Program. Clin Appl Thromb Hemost 2015;
• 8 Kukar M, Asaro J, Aquino A, Groman A, Skitzki J, Kane JM. Incidence of venous thromboembolic events in mandated risk assessment versus optional DVT prophylaxis era at a large tertiary cancer center. Am Surg 2015; 81 (09) 893-898
• 9 Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005; 51 (02/03) 70-78
• 10 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. 03) 313-318
• 11 Shuman AG, Hu HM, Pannucci CJ, Jackson CR, Bradford CR, Bahl V. Stratifying the risk of venous thromboembolism in otolaryngology. Otolaryngol Head Neck Surg 2012; 146 (05) 719-724
• 12 Pannucci CJ, Bailey SH, Dreszer G. , et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg 2011; 212 (01) 105-112
• 13 Stroud W, Whitworth JM, Miklic M. , et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol 2014; 134 (01) 160-163
• 14 Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell Jr DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg 2010; 251 (02) 344-350
• 15 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
• 16 Rogers Jr SO, Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007; 204 (06) 1211-1221
• 17 Pannucci CJ, Shanks A, Moote MJ. , et al. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg 2012; 255 (06) 1093-1099
• 18 Pannucci CJ, Laird S, Dimick JB, Campbell DA, Henke PK. A validated risk model to predict 90-day VTE events in postsurgical patients. Chest 2014; 145 (03) 567-573
• 19 Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients?. Chest 2009; 135 (02) 513-520
• 20 Hamilton WG, Reeves JD, Fricka KB, Goyal N, Engh GA, Parks NL. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty. J Arthroplasty 2015; 30 (01) 43-45
• 21 Stein PD, Matta F, Dalen JE. Is the campaign to prevent VTE in hospitalized patients working?. Chest 2011; 139 (06) 1317-1321
• 22 Kucher N, Spirk D, Kalka C. , et al. Clinical predictors of prophylaxis use prior to the onset of acute venous thromboembolism in hospitalized patients SWIss Venous ThromboEmbolism Registry (SWIVTER). J Thromb Haemost 2008; 6 (12) 2082-2087
• 23 Kulshrestha V, Kumar S. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study. J Arthroplasty 2013; 28 (10) 1868-1873
• 24 Kinnier CV, Barnard C, Bilimoria KY. The need to revisit VTE quality measures. JAMA 2014; 312 (03) 286-287
• 25 Hachey KJ, Sterbling H, Choi DS. , et al. Prevention of postoperative venous thromboembolism in thoracic surgical patients: implementation and evaluation of a Caprini risk assessment protocol. J Am Coll Surg 2016; 222 (06) 1019-1027
• 26 Pannucci CJ, Obi A, Alvarez R. , et al. Inadequate venous thromboembolism risk stratification predicts venous thromboembolic events in surgical intensive care unit patients. J Am Coll Surg 2014; 218 (05) 898-904
• 27 Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Qual Saf 2014; 23 (09) 773-780
• 28 Osborne NH, Ko CY, Upchurch Jr GR, Dimick JB. Evaluating parsimonious risk-adjustment models for comparing hospital outcomes with vascular surgery. J Vasc Surg 2010; 52 (02) 400-405
• 29 Dimick JB, Osborne NH, Hall BL, Ko CY, Birkmeyer JD. Risk adjustment for comparing hospital quality with surgery: how many variables are needed?. J Am Coll Surg 2010; 210 (04) 503-508
• 30 Beck MJ, Haidet P, Todoric K, Lehman E, Sciamanna C. Reliability of a point-based VTE risk assessment tool in the hands of medical residents. J Hosp Med 2011; 6 (04) 195-201
• 31 Pannucci CJ, Basta MN, Fischer JP, Kovach SJ. Creation and validation of a condition-specific venous thromboembolism risk assessment tool for ventral hernia repair. Surgery 2015; 158 (05) 1304-1313
• 32 Minami CA, Bilimoria KY. Are higher hospital venous thromboembolism rates an indicator of better quality? Evaluation of the validity of a hospital quality measure. Adv Surg 2015; 49: 185-204
• 33 Pannucci CJ, Jaber RM, Zumsteg JM, Golgotiu V, Spratke LM, Wilkins EG. Changing practice: implementation of a venous thromboembolism prophylaxis protocol at an academic medical center. Plast Reconstr Surg 2011; 128 (05) 1085-1092
• 34 Kahn SR, Morrison DR, Cohen JM. , et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2013; 7 (07) CD008201
• 35 Osborne NH, Wakefield TW, Henke PK. Venous thromboembolism in cancer patients undergoing major surgery. Ann Surg Oncol 2008; 15 (12) 3567-3578
• 36 White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90 (03) 446-455
• 37 Lindberg F, Bergqvist D, Rasmussen I. Incidence of thromboembolic complications after laparoscopic cholecystectomy: review of the literature. Surg Laparosc Endosc 1997; 7 (04) 324-331
• 38 Quera R, Shanahan F. Thromboembolism--an important manifestation of inflammatory bowel disease. Am J Gastroenterol 2004; 99 (10) 1971-1973
• 39 Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg 2010; 199 (1, Suppl): S3-S10
• 40 Gould MK, Garcia DA, Wren SM. , et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141 (2, Suppl): e227S-277S
• 41 Mismetti P, Laporte S, Darmon JY, Buchmüller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg 2001; 88 (07) 913-930
• 42 Bilgi K, Muthusamy A, Subair M. , et al. Assessing the risk for development of Venous Thromboembolism (VTE) in surgical patients using Adapted Caprini scoring system. Int J Surg 2016; 30: 68-73
• 43 Lobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord 2016; 4 (02) 153-160
• 44 Kaplan D, Casper TC, Elliott CG. , et al. VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest 2015; 148 (05) 1224-1230
• 45 Bahl V, Shuman AG, Hu HM. , et al. Chemoprophylaxis for venous thromboembolism in otolaryngology. JAMA Otolaryngol Head Neck Surg 2014; 140 (11) 999-1005
• 46 Davison SP, Venturi ML, Attinger CE, Baker SB, Spear SL. Prevention of venous thromboembolism in the plastic surgery patient. Plast Reconstr Surg 2004; 114 (03) 43E-51E
• 47 Seruya M, Venturi ML, Iorio ML, Davison SP. Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plast Reconstr Surg 2008; 122 (06) 1701-1708
• 48 Pannucci CJ, Barta RJ, Portschy PR. , et al. Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg 2012; 130 (02) 343-353
• 49 Murphy Jr RX, Alderman A, Gutowski K. , et al. Evidence-based practices for thromboembolism prevention: summary of the ASPS Venous Thromboembolism Task Force Report. Plast Reconstr Surg 2012; 130 (01) 168e-175e
• 50 Pannucci CJ, MacDonald JK, Ariyan S. , et al. Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg 2016; 137 (02) 709-730
• 51 Pannucci CJ, Dreszer G, Wachtman CF. , et al. Postoperative enoxaparin prevents symptomatic venous thromboembolism in high-risk plastic surgery patients. Plast Reconstr Surg 2011; 128 (05) 1093-1103
• 52 Saragas NP, Ferrao PN, Saragas E, Jacobson BF. The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery. Foot Ankle Surg 2014; 20 (02) 85-89
• 53 Hewes PD, Hachey KJ, Zhang XW. , et al. Evaluation of the Caprini model for venothromboembolism in esophagectomy patients. Ann Thorac Surg 2015; 100 (06) 2072-2078
• 54 Caprini JA. Risk assessment as a guide to thrombosis prophylaxis. Curr Opin Pulm Med 2010; 16 (05) 448-452
• 55 Barber EL, Clarke-Pearson DL. The limited utility of currently available venous thromboembolism risk assessment tools in gynecologic oncology patients. Am J Obstet Gynecol 2016; 215 (04) 445.e1-9
• 56 Bilimoria KY, Liu Y, Paruch JL. , et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217 (05) 833-42 .e1, 3
• 57 de Bastos M, Barreto SM, Caiafa JS, Boguchi T, Silva JL, Rezende SM. Derivation of a risk assessment model for hospital-acquired venous thrombosis: the NAVAL score. J Thromb Thrombolysis 2016; 41 (04) 628-635
• 58 Yen J, Van Arendonk KJ, Streiff MB. , et al. Risk factors for venous thromboembolism in pediatric trauma patients and validation of a novel scoring system: the risk of clots in kids with trauma score. Pediatr Crit Care Med 2016; 17 (05) 391-399
• 59 Van Arendonk KJ, Schneider EB, Haider AH, Colombani PM, Stewart FD, Haut ER. Venous thromboembolism after trauma: when do children become adults?. JAMA Surg 2013; 148 (12) 1123-1130
• 60 Connelly CR, Laird A, Barton JS. , et al. A clinical tool for the prediction of venous thromboembolism in pediatric trauma patients. JAMA Surg 2016; 151 (01) 50-57
• 61 Rogers FB, Shackford SR, Horst MA. , et al. Determining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System. J Trauma Acute Care Surg 2012; 73 (02) 511-515
• 62 Greenfield LJ, Proctor MC, Rodriguez JL, Luchette FA, Cipolle MD, Cho J. Posttrauma thromboembolism prophylaxis. J Trauma 1997; 42 (01) 100-103
• 63 Gearhart MM, Luchette FA, Proctor MC. , et al. The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis. Surgery 2000; 128 (04) 631-640
• 64 Cavazza S, Rainaldi MP, Adduci A, Palareti G. Thromboprophylaxis following cesarean delivery: one site prospective pilot study to evaluate the application of a risk score model. Thromb Res 2012; 129 (01) 28-31
• 65 Pannucci CJ, Swiston J, Macdonald B, Henke PK, Brooke P. Individualized venous thromboembolism risk stratification using the 2005 Caprini score to identify the benefits and harms of chemoprophylaxis in surgical patients: a meta-analysis.. Ann Surg 2017;