ABSTRACT
Kirill Lobastov
United States
An electronic search of the MEDLINE and Cochrane Library was performed on March 1, 2022, according to a prespecified and registered protocol (CRD42022311755). Studies that reported on surgical and non-surgical (medical) patients admitted to a hospital, with individual VTE risk assessed by Caprini score, and a that performed a correlation between the score and VTE incidence were included in the analysis. The primary outcome combined any symptomatic or asymptomatic deep or superficial vein thrombosis and pulmonary embolism that was reported according to the definition of the original study. A meta-analysis was not performed due to highly heterogeneous data in qualifying publications.
Results:
A total of 4562 references were identified, and 202 manuscripts were assessed for eligibility. The correlation between Caprini score and individual VTE risk was reported in 68 studies that enrolled 4207895 patients. The cohorts varied in profile and included mixed surgical and medical, medical, COVID-19, cancer, burn, trauma and orthopedics, urology and gynecology, critically ill, and a variety of other surgical patients (vascular, general, head and neck, thoracic, and plastic). In all cohorts, a significant increase in VTE incidence was observed in patients with Caprini risk scores ≥5. In patients with scores of 3-4 scores, a high rate of VTE was detected only in COVID-19 (4.5%), trauma (5.3%), and critically ill (5.5%) patients. In most cohorts, scores ≥7, ≥9, and ≥11-12 dramatically increased VTE rates. In COVID-19, cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥9 and ≥11-12 scores the VTE rates were also high (from 13% to 47%). The specific thresholds that are associated with an increased individual risk of VTE were suggested for different cohorts.
Conclusions: The Caprini score is a well-studied risk assessment model for VTE in patients with a variety of medical and surgical illnesses. The VTE rates increase dramatically when Caprini scores reach 7-11 in most patients. Further studies are needed to validate the Caprini score in other categories of illnesses that have not been well-studied (obstetrics, bariatric surgery, neurosurgery, transplantation, etc.) and establish appropriate thresholds.