In the Journals

VTE risk assessment model validated for critically ill surgical patients

The Caprini venous thromboembolism risk assessment model is valid and can be used to determine the potential for venous thromboembolism in patients who are critically ill after surgery, according to results published in JAMA Surgery.

“The 2005 version of the Caprini risk assessment model is the most widely used and well-validated risk prediction for post-surgical patients,” Andrea T. Obi, MD, in the section of vascular surgery, department of surgery, University of Michigan Health System, and fellow researchers wrote. “Despite the increased risk faced by patients in the surgical ICU, there remains a paucity of data regarding appropriate risk stratification. This study was undertaken to determine whether the Caprini risk assessment model could risk stratify a diverse group of surgical ICU patients for in-hospital VTE events.”

The study included 4,844 adults aged at least 18 years admitted to a 20-bed surgical ICU in a large tertiary care academic hospital during a 5-year period. General surgery, transplant, urology and orthopedic admissions were included, as well as patients with respiratory failure necessitating extracorporeal membrane oxygenation. Patients’ thromboprophylaxis regimens, including date, time, duration and type of anticoagulation therapy, were noted.

The researchers performed a retrospective cohort study, identifying participants through billing and quality improvement records. A validated risk-scoring method based on the 2005 Caprini model was used to determine risk for VTE in all patients. The main outcome was VTE (defined as deep vein thrombosis or pulmonary embolism) during initial admission.

Level of risk for VTE varied, ranging from low (5.3%) to super-high (14.9%), with the most common level of risk being high (31.6%). Moderate and highest levels of risk also were observed frequently (19.9% and 25.4%, respectively). Overall incidence of inpatient VTE (7.5%) increased in conjunction with risk level, according to study results. Rates of VTE were 3.5% in patients at low risk, 5.5% in patients at moderate risk, 6.6% in patients at high risk, 8.6% in patients at highest risk and 11.5% in patients at super-high risk.

Inpatient VTE occurred more often in patients with Caprini scores higher than 8 when compared with scores of 7 to 8 (OR = 1.37; 95% CI, 1.02-1.85), 5 to 6 (OR = 1.35; 95% CI, 1.16-1.57), 3 to 4 (OR = 1.3; 95% CI, 1.16-1.47) or 0 to 2 (OR = 1.37; 95% CI, 1.16-1.64). Patients with scores of 7 to 8 also were “more likely to develop inpatient VTE when compared with patients with Caprini scores of 5 to 6 (OR = 1.33; 95% CI, 1.01-1.75), 3 to 4 (OR = 1.27; 95% CI, 1.08-1.51) or 0 to 2 (OR = 1.38; 95% CI, 1.10-1.74),” the researchers wrote.

“The Caprini risk assessment model is a valid and reliable tool for the assessment of VTE risk in the surgically critically ill,” the researchers wrote. “This study supports the use of individual risk assessment in critically ill surgical patients.” – by Julia Ernst, MS 

Disclosure: The researchers report no relevant financial disclosures.

The Caprini venous thromboembolism risk assessment model is valid and can be used to determine the potential for venous thromboembolism in patients who are critically ill after surgery, according to results published in JAMA Surgery.

“The 2005 version of the Caprini risk assessment model is the most widely used and well-validated risk prediction for post-surgical patients,” Andrea T. Obi, MD, in the section of vascular surgery, department of surgery, University of Michigan Health System, and fellow researchers wrote. “Despite the increased risk faced by patients in the surgical ICU, there remains a paucity of data regarding appropriate risk stratification. This study was undertaken to determine whether the Caprini risk assessment model could risk stratify a diverse group of surgical ICU patients for in-hospital VTE events.”

The study included 4,844 adults aged at least 18 years admitted to a 20-bed surgical ICU in a large tertiary care academic hospital during a 5-year period. General surgery, transplant, urology and orthopedic admissions were included, as well as patients with respiratory failure necessitating extracorporeal membrane oxygenation. Patients’ thromboprophylaxis regimens, including date, time, duration and type of anticoagulation therapy, were noted.

The researchers performed a retrospective cohort study, identifying participants through billing and quality improvement records. A validated risk-scoring method based on the 2005 Caprini model was used to determine risk for VTE in all patients. The main outcome was VTE (defined as deep vein thrombosis or pulmonary embolism) during initial admission.

Level of risk for VTE varied, ranging from low (5.3%) to super-high (14.9%), with the most common level of risk being high (31.6%). Moderate and highest levels of risk also were observed frequently (19.9% and 25.4%, respectively). Overall incidence of inpatient VTE (7.5%) increased in conjunction with risk level, according to study results. Rates of VTE were 3.5% in patients at low risk, 5.5% in patients at moderate risk, 6.6% in patients at high risk, 8.6% in patients at highest risk and 11.5% in patients at super-high risk.

Inpatient VTE occurred more often in patients with Caprini scores higher than 8 when compared with scores of 7 to 8 (OR = 1.37; 95% CI, 1.02-1.85), 5 to 6 (OR = 1.35; 95% CI, 1.16-1.57), 3 to 4 (OR = 1.3; 95% CI, 1.16-1.47) or 0 to 2 (OR = 1.37; 95% CI, 1.16-1.64). Patients with scores of 7 to 8 also were “more likely to develop inpatient VTE when compared with patients with Caprini scores of 5 to 6 (OR = 1.33; 95% CI, 1.01-1.75), 3 to 4 (OR = 1.27; 95% CI, 1.08-1.51) or 0 to 2 (OR = 1.38; 95% CI, 1.10-1.74),” the researchers wrote.

“The Caprini risk assessment model is a valid and reliable tool for the assessment of VTE risk in the surgically critically ill,” the researchers wrote. “This study supports the use of individual risk assessment in critically ill surgical patients.” – by Julia Ernst, MS 

Disclosure: The researchers report no relevant financial disclosures.

    See more from Anticoagulation Resource Center