The original and modified Caprini score equally predicts venous thromboembolism in COVID-19 patients

Abstract

Objective The study aimed to validate the original Caprini score and its modifications considering coronavirus disease (COVID-19) as a severe prothrombotic condition in patients admitted to the hospital. Methods The relevant data were extracted from the electronic medical records with an implemented Caprini score and were retrospectively evaluated. The score was calculated twice: by the physician upon admission and by the investigator at discharge (death). The final assessment considered additional risk factors that occurred during inpatient treatment. Besides the original Caprini score (a version of 2005), the modified version added the elevation of D-dimer and specific scores for COVID-19 as follows: 2 points for asymptomatic, 3 points for symptomatic, and 5 points for symptomatic infection with positive D-dimer. Cases were evaluated retrospectively. The primary endpoint was symptomatic venous thromboembolism (VTE) detected during inpatient treatment and confirmed by appropriate imaging testing or autopsy. The secondary endpoints included those observed during hospitalization (admission to the intensive care unit (ICU), a requirement for invasive mechanical ventilation (IMV), death, bleeding), and those assessed at 6-month follow-up (symptomatic VTE, bleeding, death). The association of eight different versions of the Caprini score with VTE events was evaluated. Results A total of 168 patients (83 males and 85 females at the age of 58.3±12.7 years old) were admitted to the hospital between 30 April and 29 May, 2020, and were discharged or died to the time of data analysis. The original Caprini score varied between 2-12 (5.4±1.8) at the admission and between 2-15 (5.9±2.5) at discharge or death. The maximal score was observed with modification including specific COVID-19 points of 5-20 (10.0±3.0). Patients received prophylactic (enoxaparin 40 mg once daily: 2.4%), intermediate (enoxaparin 80 mg once daily: 76.8%), or therapeutic (enoxaparin 1 mg/kg twice daily: 20.8%) anticoagulation. Despite this, symptomatic VTE was detected in 11 (6.5%) inpatients. Out of the 168 individuals, 28 (16.7%) admitted to the ICU, 8 (4.8%) required IMV, and 8 (4.8%) died. Clinically relevant non-major bleeding was detected in two (1.2%) cases. The Caprini score of all eight versions demonstrated a significant association with inpatient VTE frequency. The highest predictability was observed for the original scale when assessed at discharge (death). Only symptomatic VTE was reported after discharge with a cumulative incidence of 7.1%. This did not affect the predictability of the Caprini score. Extended antithrombotic treatment was prescribed to 49 (29%) patients with a cumulative incidence of bleeding of 1.8% at 6 months. Conclusion The study identified a significant correlation between the Caprini score and the risk of VTE in COVID-19 patients. All models including specific COVID-19 scores showed equally high predictability, and ...

Validation of a modified Caprini risk assessment model in lung cancer patients undergoing surgery: Results of a multicenter cross‐sectional observational study

“…41 Some investigations also attempted to incorporate D-dimer results into Caprini RAM. 16,42,43 However, the efficacy of inclusion of D-dimer remains far from resolved, probably because in these studies, the optimal cutoff value of D-dimer level was independently acquired and was simply combined to risk models.…”

“…Tsaplin et al 16 completed a modified Caprini RAM by introducing D-dimer >3 times the upper limit of normal (0.55 mg/L) as an indicator of acquired thrombophilia, they discovered that the modified Caprini RAM was non-inferior to the original one. In patients undergoing surgery to remove tumors, the postoperative elevation of D-dimer is prevalent, therefore we adopted their method that conferred stricter inclusion of abnormal D-dimer.…”

“…The introduction of Ddimer in Caprini RAM has improved the predictability for VTE in colorectal cancer and severely infected patients. 16,17 Robust evidence to support sufficient prerequisites of D-dimer to be included in Caprini risk model that was applicable for lung cancer surgery patients are needed.…”

PERTinent new insights into venous thromboembolism risk and management in hospitalized patients with COVID-19

“…15 As these studies begin to report their findings, a key priority is to improve VTE risk stratification methods for patients with COVID-19 so that a more personalized approach to VTE prevention can be implemented. 16,17 Although another pandemic on the scale of COVID-19 is unlikely in the near future, lessons learned from 2020 can help to prepare for future management plans. For example, PERTs should consider how best to manage patients when infectious concerns limit access to diagnostic and therapeutic modalities.…”

The effectiveness and safety of the use of antithrombotic therapy in COVID-19

“…Все они прошли определенную валидацию у больных коронавирусным заболеванием. В рамках проспективного исследования с участием 274 пациентов было показано, что лица с ≥ 4 балла Padua имеют более высокий уровень Д-димера, С-реактивного белка, IL-6, чаще получают фармакопрофилактику, вопреки которой чаще отмечается летальный исход (40,5 против 5,9%) [4]. Между тем ассоциация между частотой развития ВТЭО и баллом Padua не была оценена.…”