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Scope of the Caprini score
The Caprini score is used to predict the risk of postoperative venous thromboembolism (VTE) in surgical patients. The result stratifies VTE risk and helps decide which patients should continue thromboprophylaxis after discharge.
The original study did not include recommendations on VTE prophylaxis; however, the score has been validated in many cohorts of surgical patients. It is most widely validated for VTE risk assessment in surgical patients, including general, plastic, vascular and ENT / head and neck surgery, as well as surgical patients in the intensive care unit.
How the score is calculated
The Caprini score consists of questions about various thrombosis risk factors. Higher point values indicate a greater VTE risk. The score is the sum of the points for every item: the higher the total, the higher the risk of VTE.
| Criterion | Points |
|---|---|
| Age 41–60 years | 1 |
| Swollen legs (current) | 1 |
| Varicose veins | 1 |
| Obesity (body mass index > 25 kg/m²) | 1 |
| Sepsis (< 1 month) | 1 |
| Serious lung disease, including pneumonia (< 1 month) | 1 |
| Oral contraceptives or hormone replacement therapy | 1 |
| Pregnancy or postpartum period (< 1 month) | 1 |
| History of unexplained stillbirth, recurrent spontaneous abortion (3 or more), premature birth with toxaemia or growth-restricted infant | 1 |
| Acute myocardial infarction | 1 |
| Congestive heart failure (current or < 1 month) | 1 |
| Patient currently at bed rest | 1 |
| History of inflammatory bowel disease | 1 |
| Abnormal pulmonary function (COPD) | 1 |
| Other risk factor | 1 |
| Minor surgery | 1 |
| Age 61–74 years | 2 |
| Confined to bed for more than 72 hours | 2 |
| Major surgery in the past month | 2 |
| Malignancy (present or previous) | 2 |
| Limb immobilisation, e.g. plaster cast (< 1 month) | 2 |
| Central venous access | 2 |
| Arthroscopic surgery | 2 |
| Laparoscopic surgery (> 60 min) | 2 |
| Major surgery (> 45 min) | 2 |
| Age 75 years or older | 3 |
| History of VTE (DVT / PE) | 3 |
| Factor V Leiden mutation | 3 |
| Prothrombin 20210A mutation | 3 |
| Positive lupus anticoagulant | 3 |
| Family history of VTE | 3 |
| Hyperhomocysteinaemia | 3 |
| Heparin-induced thrombocytopenia (HIT) | 3 |
| Elevated anticardiolipin antibodies | 3 |
| Other congenital or acquired thrombophilia | 3 |
| Stroke (< 1 month) | 5 |
| Acute spinal cord injury with paralysis (< 1 month) | 5 |
| Multiple trauma (< 1 month) | 5 |
| Major joint replacement (arthroplasty) | 5 |
| Fracture of a limb or the pelvis | 5 |
Interpretation of the Caprini score
- 0–1 point — very low risk (about 0.5%)
- 2 points — low risk (about 1.5%)
- 3–4 points — moderate risk (about 3%)
- 5 points or more — high risk (about 6%)
Once the score reaches 10 or more, the risk of VTE has been shown to rise substantially.
Definitions of the risk factors
Age. Venous thromboembolism is rare in children and young adults. Patients over 40 are at a considerably higher risk, and the risk roughly doubles with each subsequent decade.
Type of surgery. Minor surgery refers not to the type of operation but to an anaesthesia time of less than 45 minutes. Major surgery is defined as a procedure under general or regional anaesthesia lasting more than 45 minutes. Repeat operations during the same hospital stay score 2 points each if the anaesthesia time exceeds 45 minutes.
Major surgery (within the past month). Major surgery performed during the previous month, including earlier stages of staged procedures.
Sepsis. Defined as infection requiring intravenous antibiotics. Infection promotes thrombosis through endothelial injury, tissue factor–induced activation of the procoagulant pathway, suppression of the natural anticoagulant pathways and inhibition of fibrinolysis.
Pneumonia. Both preoperative and postoperative pneumonia are significant risk factors for VTE.
Immobilising plaster cast. Includes any device that impairs the calf muscle pump by restricting ankle movement.
Hip, pelvis or leg fracture. These fractures are associated with an increased VTE risk, and the degree of risk depends on the fracture site. Toe fractures were not included in the study used to develop the score.
Stroke. Paradoxical embolism can occur when a DVT travels to the heart and passes through a patent foramen ovale into the systemic circulation, causing a thrombotic stroke. Another common cause of embolic stroke is atrial fibrillation. A previous thrombotic stroke should be counted as a history of thrombosis and scored as 3 points.
Multiple trauma. Includes patients with multiple injuries, such as fractures, severe chest and abdominal contusions, and injuries to internal organs.
Acute spinal cord injury with paralysis. Patients often do not report symptoms because of the nature of their nerve damage. The first manifestation of VTE may be extensive thrombosis and/or death.
Varicose veins. Visible bulging veins, not spider veins or telangiectasias. This risk factor is especially relevant in patients with cancer.
Current swollen legs. Leg swelling includes local oedema at any level, loss of the contour of bony prominences, smoothing of the superficial veins of the foot, or indentations on the leg after removing a stocking. The factor applies to one or both legs.
Current central venous access. A catheter in a vein of the arm, neck or chest that delivers blood or medication directly to the heart within the past month (central venous catheter, port, PICC line).
History of DVT, PE or thrombotic stroke. Includes every episode of venous thrombosis at any site, as well as pulmonary embolism. DVT and PE together still score 3 points.
Family history of thrombosis. One of the most powerful risk factors for thrombosis. An increased risk has been reported in first-, second- and third-degree relatives. This includes any DVT, PE or thrombotic stroke.
Other congenital or acquired thrombophilia. A family history of VTE scores 3 points. If the patient also has a positive thrombophilia marker, the score becomes 6 points. Multiple thrombophilia markers together increase the VTE potential and score 3 points each.
Mobility. Bed rest is defined as being unable to walk 10 metres at a time. Bathroom privileges or walking around the ward do not count as ambulation.
History of inflammatory bowel disease. This risk factor includes regional ileitis (Crohn’s disease), ulcerative colitis and similar conditions. Patients with both inactive and active disease should be included; the risk of thrombosis increases during active disease.
Acute myocardial infarction. Associated with a transiently increased risk of VTE during the first six months, independently of traditional atherosclerotic risk factors. The strength of this risk factor decreases after three months.
COPD. A leading cause of morbidity and mortality worldwide, characterised by systemic inflammation; venous thromboembolism occurs in up to 30% of these patients.
Present or previous malignancy. Excludes non-melanoma skin cancer such as basal cell carcinoma (melanoma counts). VTE is one of the leading causes of death in patients with cancer.
Positive factor V Leiden. The most common inherited mutation predisposing to thrombosis. It is associated with an increased risk of VTE, especially in the rare homozygous form, and with a higher likelihood of both arterial and venous thrombosis.
Positive prothrombin 20210A. Associated with elevated plasma levels of coagulation factor II, a risk factor for venous thrombosis, especially in the rare homozygous form. Heterozygous factor V Leiden combined with a heterozygous prothrombin gene mutation carries a thrombotic risk similar to that of a single homozygous defect.
Heparin-induced thrombocytopenia. A potent and sometimes life-threatening immune reaction to heparin that results in thrombocytopenia and, in some cases, thrombosis (HITT). The reaction is much less frequent with low-molecular-weight heparin than with unfractionated heparin.
Methylenetetrahydrofolate reductase (MTHFR). This enzyme plays a central role in folate metabolism, and genetic variants, especially C677T, have been linked to thrombotic events. MTHFR deficiency can lead to hyperhomocysteinaemia. Elevated serum homocysteine has not been proven to be associated with venous thrombosis; its link with VTE remains controversial.
Antiphospholipid syndrome (APS). Associated with both venous and arterial thrombosis, and particularly with obstetric complications. Laboratory abnormalities include lupus anticoagulant (LA), anticardiolipin antibodies (ACA) and anti-β2-glycoprotein I antibodies.
Blood transfusion. Transfusion of 1–2 units of blood stored for more than 28 days increases the incidence of DVT and mortality in trauma patients. The incidence of DVT rises in ventral hernia repair, in bariatric surgery patients and with blood transfusion, and up to 50% of these events occur after discharge. VTE is more frequent in cancer patients who receive red blood cell transfusions.
Smoking. Smoking is defined as inhaling anything that burns, including marijuana, or vaping. Smokers were more likely to develop postoperative VTE than people who had never smoked.
Diabetes mellitus requiring insulin. The overall incidence of DVT and PE was higher in patients with type 2 diabetes than in controls. Patients with type 1 and type 2 diabetes are at increased risk of recurrent VTE.
Human immunodeficiency virus (HIV). The disease activates multiple inflammatory, immunological and coagulation pathways, which puts these patients at increased risk of VTE.
Chemotherapy. Incidental VTE is a relatively common finding in patients with solid tumours, especially during the first months of chemotherapy. Patients with multiple myeloma are at increased risk of venous thromboembolism, particularly when treated with thalidomide or lenalidomide in combination with dexamethasone and/or chemotherapy.
Superficial vein thrombosis (SVT). Superficial vein thrombosis combined with an acquired thrombotic risk factor increases the risk of venous thrombosis 10- to 100-fold. Isolated SVT often progresses to DVT and PE. Cancer patients with SVT have a poor prognosis, as do cancer patients with DVT, and recurrence rates are high.
Author of the Caprini score (Caprini Risk Score)
The score was developed by Joseph Caprini, MD, MS, Senior Clinician Educator at the University of Chicago Pritzker School of Medicine and Emeritus physician at NorthShore University HealthSystem in Evanston, Illinois, USA.
The Caprini score was first published in 1991 in Seminars in Thrombosis and Hemostasis. It was designed as a prospective tool for assessing the risk of postoperative venous thromboembolism (VTE).
Official website of the Caprini score
References
- Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. «Clinical assessment of venous thromboembolic risk in surgical patients.» Seminars in Thrombosis and Hemostasis. Vol. 17. 1991. PMID: 1754886
- Bahl V, et al. «A validation study of a retrospective venous thromboembolism risk scoring method.» Annals of Surgery 251.2 (2010): 344-350.
- Venous thromboembolism prophylaxis using the Caprini score. Golemi I, Salazar Adum JP, Tafur A, Caprini J. Dis Mon. 2019 Aug;65(8):249-298. doi: 10.1016/j.disamonth.2018.12.005. Epub 2019 Jan 9. PMID: 30638566 Review.
- Completion of the Updated Caprini Risk Assessment Model (2013 Version). Cronin M, Dengler N, Krauss ES, Segal A, Wei N, Daly M, Mota F, Caprini JA. Clin Appl Thromb Hemost. 2019 Jan-Dec; 25:1076029619838052. doi: 10.1177/1076029619838052. PMID: 30939900 Free PMC article. Review.
- Lobastov KV, Barinov VE, Schastlivtsev IV, Laberko LA. Caprini score as an individual risk assessment tool for postoperative venous thromboembolism in patients with high surgical risk [in Russian]. Khirurgiia (Mosk). 2014;(12):16‑23.
- The original and modified Caprini score equally predicts venous thromboembolism in COVID-19 patients. Tsaplin S, Schastlivtsev I, Zhuravlev S, Barinov V, Lobastov K, Caprini JA. J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1371-1381.e4. doi: 10.1016/j.jvsv.2021.02.018. Epub 2021 Mar 17. PMID: 33744497 Free PMC article.
- Venous thromboembolism prophylaxis using the Caprini score. Leikin JB. Dis Mon. 2019 Aug;65(8):248. doi: 10.1016/j.disamonth.2018.12.004. Epub 2018 Dec 28. PMID: 30598196
- Surgical venous thromboembolism prophylaxis: clinical practice update. Segon YS, Summey RD, Slawski B, Kaatz S. Hosp Pract (1995). 2020 Dec;48(5):248-257. doi: 10.1080/21548331.2020.1788893. Epub 2020 Aug 1. PMID: 32589468 Review.
- Systematic review of venous thromboembolism risk categories derived from Caprini score. Hayssen H, Cires-Drouet R, Englum B, Nguyen P, Sahoo S, Mayorga-Carlin M, Siddiqui T, Turner D, Yesha Y, Sorkin JD, Lal BK. J Vasc Surg Venous Lymphat Disord. 2022 Nov;10(6):1401-1409.e7. doi: 10.1016/j.jvsv.2022.05.003. Epub 2022 Aug 2. PMID: 35926802 Review.
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