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.

Assessing the Risk for Development of Deep Vein Thrombosis among Chinese Patients using the 2010 Caprini Risk Assessment Model: A Prospective Multicenter Study

“…The 2010 version has not been formally validated in a large series of patients. Some studies have compared the 2010 and 2005 versions 7) , with controversial results. Moreover, our results indicated that the 2010 Caprini RAM is less effective in assessing DVT risk among nonsurgical patients than surgical ones.…”

“…In addition, many past studies used a retrospective design, which may have led to inaccurate assessments. In addition, evidence is inconsistent regarding whether the 2010 Caprini RAM is suitable for recommendation [6][7][8] . Therefore, prospective validation of this model among Chinese inpatients is needed.…”

Perioperative Venous Thromboembolism Prophylaxis

“…Several risk-assessment models (RAMs) have been developed to estimate the risk of postoperative VTE. [24][25][26][27][28] These have identified over a 20-fold variation in risk of postoperative VTE and can explain more than 70% of the variation in risk of postoperative VTE. 24 The advantage of RAMs is that they not only can separate patients at a high risk of VTE who will likely benefit from prophylactic measures but that they also identify patients at very low risk of thrombosis who could avoid unnecessary pharmacoprophylaxis.…”

“…Several other RAMs have been developed by using large administrative datasets. 24,27,28 These RAMs are designed for either patients undergoing any operation or operation-specific groups. A common limiting factor for these RAMs is the lack of external validation.…”

Clinical Scoring Systems in Thrombosis and Hemostasis

“…Several articles are devoted to the use of CSSs for venous thromboembolism (VTE). The first three articles focus on CSSs for estimating the risk of VTE in surgical patients, 10 hospitalized medical patients, 11 and patients with cancer. 12 The next article summarizes the role of CSSs in diagnostic pathways for VTE.…”