Utilization of the Caprini Score for Risk Stratification of the Arthroplasty Patient in the Prevention of Postoperative Venous Thrombosis

Abstract

Venous thromboembolism (VTE) is a serious and predictable complication following arthroplasty. It has been recognized that a strategy utilizing individualized anticoagulation choices based on patient risk stratification results in improved patient outcomes. A 2013 version of the Caprini Risk Score has previously been validated for use in total joint arthroplasty. A Caprini score of 10 or greater assesses the patient as “high risk” while 9 or less is considered “low risk.” Patients scored as “low risk” for postoperative VTE receive enteric coated aspirin 81 mg twice a day for 6 weeks. Patients scored as “high risk” for VTE are prescribed apixaban. This retrospective cohort study was conducted to assess the safety and efficacy of the thromboprophylaxis treatment prescribed based on a standardized risk assessment protocol for the calendar year 2020. Patients having total hip arthroplasty, total knee arthroplasty, revision total hip arthroplasty, revision total knee arthroplasty, or bilateral arthroplasties by 13 surgeons (N = 873) were reviewed. Patients were risk assessed using the Caprini Risk Score and thromboprophylaxis was prescribed based on the score obtained. The annual rate of VTE was 0.2%. The Caprini Risk Score is an effective approach to individualize thromboprophylaxis choices after total joint arthroplasty.

Keywords

Caprini Risk Score - risk stratification - thromboprophylaxis - aspirin - apixaban - arthroplasty

Publikationsverlauf

Artikel online veröffentlicht:
28. Februar 2022

• References

• 1 Falck-Ytter Y, Francis CW, Johanson NA. et al. Prevention of VTE in Orthopedic Surgery Patients Antithrombotic Therapy and Prevention of Thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST. 2012; 141 (02) )(Suppl): e278S-e325S
• 2 Leizorovicz A. Long-term consequences of deep vein thrombosis. Haemostasis 1998; 28 (Suppl. 03) 1-7
• 3 Office of the Surgeon General (US), National Heart, Lung and Blood Institute. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Rockville, MD: Office of the Surgeon General; 2008
• 4 Caprini JA, Botteman MF, Stephens JM. et al. Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States. Value Health 2003; 6 (01) 59-74
• 5 Johanson NA, Lachiewicz PF, Lieberman JR. et al; Adopted by the American Academy of Orthopaedic Surgeons Board of Directors. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg 2009; 17 (03) 183-196
• 6 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism:. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest; 2008. 133. (6 Suppl): 381S-453S
• 7 American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Preventing Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty. Accessed September 23, 2011 at: https://www.aaos.org/globalassets/quality-and-practice-resources/vte/vte_full_guideline_10.31.16.pdf.
• 8 Parvizi J, Huang R, Raphael IJ, Arnold WV, Rothman RH. Symptomatic pulmonary embolus after joint arthroplasty: stratification of risk factors. Clin Orthop Relat Res 2014; 472 (03) 903-912
• 9 Parvizi J, Huang R, Rezapoor M, Bagheri B, Maltenfort MG. Individualized risk model for venous thromboembolism after total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 180-186
• 10 Bohl DD, Maltenfort MG, Huang R, Parvizi J, Lieberman JR, Della Valle CJ. Development and validation of a risk stratification system for pulmonary embolism after elective primary total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 187-191
• 11 Luksameearunothai K, Sa-Ngasoongsong P, Kulachote N. et al. Usefulness of clinical predictors for preoperative screening of deep vein thrombosis in hip fractures. BMC Musculoskelet Disord 2017; 18 (01) 208
• 12 Saragas NP, Ferrao PN, Saragas E, Jacobson BF. The impact of risk assessment on the implementation of venous thromboembolism prophylaxis in foot and ankle surgery. Foot Ankle Surg 2014; 20 (02) 85-89
• 13 Krauss ES, Segal A, Cronin M. et al. Implementation and validation of the 2013 Caprini score for risk stratification of arthroplasty patients in the prevention of venous thrombosis. Clin Appl Thromb Hemost 2019; 25: 1076029619838066
• 14 Hatef DA, Kenkel JM, Nguyen MQ. et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg 2008; 122 (01) 269-279
• 15 Seruya M, Venturi ML, Iorio ML, Davison SP. Efficacy and safety of venous thromboembolism prophylaxis in highest risk plastic surgery patients. Plast Reconstr Surg 2008; 122 (06) 1701-1708
• 16 Lobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord 2016; 4 (02) 153-160
• 17 Stroud W, Whitworth JM, Miklic M. et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol 2014; 134 (01) 160-163
• 18 Eliquis® (apixaban) [package insert]. Princeton, NJ: Bristol-Myers Squibb. 2012 . Accessed December 9, 2021 at: https://packageinserts.bms.com/pi/pi_eliquis.pdf
• 19 Parvizi J, Huang R, Restrepo C. et al. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: a preliminary analysis. J Bone Joint Surg Am 2017; 99 (02) 91-98
• 20 Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108 (03) 308-328 , quiz 329
• 21 Lanza FL, Chan FK, Quigley EM. Practice Parameters Committee of the American College of Gastroenterology. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 2009; 104 (03) 728-738
• 22 Illinois State Medical Society. . Accessed March 31, 2021 at: https://www.venousdisease.com/caprini-dvt-risk-assessment.pdf
• 23 Cronin M, Dengler N, Krauss ES. et al. Completion of the updated Caprini risk assessment model (2013 version). Clin Appl Thromb Hemost 2019; 25: 1076029619838052
• 24 Anderson DR, Dunbar M, Murnaghan J. et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 2018; 378 (08) 699-707
• 25 Kulshrestha V, Kumar S. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study. J Arthroplasty 2013; 28 (10) 1868-1873
• 26 Nam D, Nunley RM, Johnson SR, Keeney JA, Clohisy JC, Barrack RL. Thromboembolism prophylaxis in hip arthroplasty: routine and high risk patients. J Arthroplasty 2015; 30 (12) 2299-2303
• 27 González Della Valle A, Serota A, Go G. et al. Venous thromboembolism is rare with a multimodal prophylaxis protocol after total hip arthroplasty. Clin Orthop Relat Res 2006; 444 (444) 146-153
• 28 Vulcano E, Gesell M, Esposito A, Ma Y, Memtsoudis SG, Gonzalez Della Valle A. Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol. Int Orthop 2012; 36 (10) 1995-2002
• 29 Warren JA, Sundaram K, Anis HK, Kamath AF, Higuera CA, Piuzzi NS. Have venous thromboembolism rates decreased in total hip and knee arthroplasty?. J Arthroplasty 2020; 35 (01) 259-264
• 30 Fahrni J, Husmann M, Gretener SB, Keo HH. Assessing the risk of recurrent venous thromboembolism–a practical approach. Vasc Health Risk Manag 2015; 11: 451-459
• 31 Mont MA, Jacobs JJ, Boggio LN. et al; AAOS. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011; 19 (12) 768-776