DVT / VTE risk assessment scores and tools

see also:

Caprini RAM score

originally designed for surgical inpatients
BUT was UNABLE to identify a subset of non-ICU medical inpatients who would benefit from pharmacologic prophylaxis ¹⁾

scoring tool

5 points for each of:
- stroke
- Acute spinal cord injury or paralysis (<1 mo)
- Hip, pelvis, or leg fracture (<1 mo)
- Multiple trauma (<1 mo)
3 points for each of:
- Age ≥ 75yrs
- History of DVT/PE
- Family history of VTE
- History of thrombophilia
- Heparin-induced thrombocytopenia (HIT)
2 points for each of:
- Age 61–74yrs
- Positive history of cancer
- Immobilizing plaster cast
- Patient confined to bed (>=72 h)
1 point for each of:
- Age 41–60yrs
- Congestive heart failure
- COPD or abnormal pulmonary function
- Inflammatory bowel disease
- Severe lung disease (including pneumonia)
- Acute myocardial infarction
- Sepsis (<1 mo)
- Surgery (< 1 mo)
- Postpartum (<1 mo)
- History of unexpected stillborn infant, recurrent spontaneous abortion (>=3), or premature birth
- Varicose veins
- Obesity (BMI > 25)
- Swollen legs (current)
- Central venous catheter present on admission

utility of Caprini score

surgical inpatients
- study of 200,000 surgical admissions ²⁾
  - rate of clinical VTE ranged from 0.26% to 1.2% depending upon surgical procedure undergone
  - Caprini score < 2 = zero VTE events
  - Caprini score > 8 = 6.5% VTE event in 30 days
non-ICU non-pregnant, medical adult inpatients with hospital LOS of at least 2 days:
- almost 64,000 non-ICU medical inpatients were studied and a 1% VTE event within 90 days of admission was detected ³⁾
  - a linear association between the Caprini RAM and risk of VTE was noted up to a Caprini score of 10
  - HOWEVER it was UNABLE to identify a subset of non-ICU medical inpatients who would benefit from pharmacologic prophylaxis
  - strongest independent predictors of VTE were central venous catheter on admission, PH or FH VTE, admission or treatment of cancer in the past year, and current immobility
  - Even among patients with Caprini scores ≥ 5 who did not receive pharmacologic prophylaxis, the 90-day rate of VTE was less than 2.0 per 10,000 patient-days and thus because rates of VTE are so low, the findings raise questions regarding existing VTE prevention strategies that often advocate for routine use of pharmacologic prophylaxis in hospitalized medical patients
  - not able to identify a clear Caprini threshold that effectively isolates a patient sub-group that may benefit from pharmacologic VTE prophylaxis
  - administration of pharmacologic prophylaxis to nearly 500 non-surgical, non-ICU, medical patients with Caprini scores ≥ 5 would be needed to prevent a single VTE event - VTE event rate without prophylaxis is 1.6% and VTE event rate with prophylaxis 1.4% and this group constitutes 80% of these inpatients

Padua Prediction Score

https://www.mdcalc.com/padua-prediction-score-risk-vte
hospitalized patients who are high risk (Padua ≥4) could benefit from thromboprophylaxis
yet to be validated in large prospective studies
a retrospective review of review of patients with sepsis found no relationship between a Padua ≥4 and VTE

UHSM Plaster Cast VTE risk assessment tool

small pilot study ⁴⁾
chemoprophylaxis given if score > 13
none of the 53 patients developed VTE, 12 were given chemoprophylaxis
requires validation

UHSM score

age: 41-50yrs = 1; 51-60yrs = 2; > 60yrs = 3;
BMI: 25-29 = 2; 30-40 = 3; > 40 = 4;
mobility: self aids = 1; needs assistance = 2; chair bound = 3; bed bound = 4; long haul travel > 4hrs = 3;
hormonal risk: OCP/HRT past 4 wks = 3; pregnancy/puerperium = 4;
trauma risk: wt bearing cast = 2; non-wt bearing cast = 4;
medical risk:
- 6pts for each of: acute stroke; thrombophilia/PH VTE; active cancer;
- 4pts for acute infection
- 3pts for each of: acute colitis/IBD; acute rheum disease; CCF/COPD; chemoRx past 6wks;
- 2pts for each of: anaemia; paraproteinaemia; nephrotic syndrome;