Archive Staff & Patient Safety 2017

Are Your Patients at Risk of DVT?

The vascular surgeon who created the Caprini Score discusses how to protect your patients from life-threatening blood clots.

Joseph Caprini

Joseph Caprini

BIO

sequential compression devices SQUEEZE PLAY Applying sequential compression devices during surgery effectively prevents the physiological risk factors of clotting.

Although it's preventable, almost 300,000 Americans die annually from deep vein thrombosis (DVT) and its primary complication, pulmonary embolism. Fortunately, if caught in time, DVT is completely treatable. The classic signs of DVT, especially if it occurs in the lower extremities, are leg pain, swelling, tenderness, and redness or discoloration of the skin. The bad news is that, about half of the time, DVT has no symptoms at all. The first and most important step in protecting your patients from a potentially fatal DVT is to know whether they are at risk.

I'm the creator of the widely used Caprini DVT Risk Assessment, which generates a total clotting risk score ("Caprini Score") based on a patient's health history and comorbidities (osmag.net/6cywtg). Your surgical team has complete control over identifying the factors that can lead to DVT, and should use Caprini Scores to guide their prophylaxis efforts.

Scores ≤ 5. Patients require basic prophylaxis with pneumatic compression stockings or sequential compression devices.

Scores of 5 to 8. Patients are at heightened risk of clotting and require a week of post-operative anticoagulant prophylaxis.

Scores ≥ 8. Patients are at significant risk of post-op clotting and should receive a month of anticoagulant therapy.

Patients with a history or family history of thrombosis and abdominal surgery for cancer should receive 30 days of prophylaxis, even with scores < 8.

Don't be lulled into believing that minor surgery doesn't hold major blood-clotting risks. Although the surgery may be minor, any procedure requiring general or regional anesthesia lasting longer than 1 hour poses a thrombotic risk. Outpatients are just as likely as inpatients to suffer clots, because of the anesthesia time.

With proper pre-op risk assessment and appropriate prophylaxis, the risk of DVT can drop to as low as 0.3%. Without both, the risk soars to 5% to 10%. What's the most effective anticoagulant prophylaxis therapy? That's a decision you'll make on a case-by-case basis. What matters more is that the therapy is used for as long as patients are deemed to be at risk of developing clots.

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