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Clinical Trial
. 2016 May;129(5):528-535.
doi: 10.1016/j.amjmed.2015.10.027. Epub 2015 Nov 6.

Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

Paul J Grant #  1   2 , M Todd Greene #  1   2 , Vineet Chopra  1   2   3 , Steven J Bernstein  1   2   3 , Timothy P Hofer  1   3 , Scott A Flanders  1   2
Affiliations
Clinical Trial

Assessing the Caprini Score for Risk Assessment of Venous Thromboembolism in Hospitalized Medical Patients

Paul J Grant et al. Am J Med. 2016 May.

Abstract

Background: The optimal approach to assess risk of venous thromboembolism in hospitalized medical patients is unknown. We examined how well the Caprini risk assessment model predicts venous thromboembolism in hospitalized medical patients.

Methods: Between January 2011 and March 2014, venous thromboembolism events and risk factors were collected from non-intensive care unit medical patients hospitalized in facilities across Michigan. After calculation of the Caprini score for each patient, mixed logistic spline regression was used to determine the predicted probabilities of 90-day venous thromboembolism by receipt of pharmacologic prophylaxis across the Caprini risk continuum.

Results: A total of 670 (1.05%) of 63,548 eligible patients experienced a venous thromboembolism event within 90 days of hospital admission. The mean Caprini risk score was 4.94 (range, 0-28). Predictive modeling revealed a consistent linear increase in venous thromboembolism for Caprini scores between 1 and 10; estimates beyond a score of 10 were unstable. Receipt of pharmacologic prophylaxis resulted in a modest decrease in venous thromboembolism risk (odds ratio, 0.85; 95% confidence interval, 0.72-0.99; P = .04). However, the low overall incidence of venous thromboembolism led to large estimates of numbers needed to treat to prevent a single venous thromboembolism event. A Caprini cut-point demonstrating clear benefit of prophylaxis was not detected.

Conclusions: Although a linear association between the Caprini risk assessment model and the risk of venous thromboembolism was noted, an extremely low incidence of venous thromboembolism events in non-intensive care unit medical patients was observed. The Caprini risk assessment model was unable to identify a subset of medical patients who benefit from pharmacologic prophylaxis.

Keywords: Caprini risk assessment model; Deep venous thrombosis; Pharmacologic prophylaxis; Pulmonary embolism; Venous thromboembolism.

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Figures

Figure 1
Figure 1. Hospital Rates of VTE Prophylaxis by Caprini Score
The predicted prophylaxis rate averaged over hospitals is shown by the black line with 95% confidence intervals based on the linear spline random effects model. The observed prophylaxis rate by hospital is shown with the light gray circles and the predicted empirical Bayes mean prophylaxis rate by hospital is shown with the small x’s. Overall rates of prophylaxis plateau after a Caprini score of 5.
Figure 2
Figure 2. Predicted 90-day VTE by Caprini Score and Receipt of Pharmacologic Prophylaxis
The predicted 90-day mean VTE rate averaged over hospitals is shown for those with and without pharmacologic prophylaxis with 95% CI. The relationship to Caprini score is modeled as a piecewise linear spline using knots based on the unique quantiles in the data. The triangles are a binned scatterplot of the raw data representing a non-parametric way of displaying the relationship between Caprini score and VTE.
See this image and copyright information in PMC

Comment in

  • Caprini Score in Hospitalized Medical Patients.
    Tafur AJ, Arcelus JI. Tafur AJ, et al. Am J Med. 2016 Oct;129(10):e265. doi: 10.1016/j.amjmed.2016.03.014. Am J Med. 2016. PMID: 27671858 No abstract available.
  • The Reply.
    Grant PJ, Greene MT, Flanders SA. Grant PJ, et al. Am J Med. 2016 Oct;129(10):e267. doi: 10.1016/j.amjmed.2016.05.036. Am J Med. 2016. PMID: 27671859 No abstract available.

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