The Caprini Score is a risk assessment tool used by medical professionals to determine a patient’s likelihood of developing a venous thromboembolism (VTE). A VTE is a blood clot in a vein and includes deep vein thrombosis (DVT), a clot in the leg, and pulmonary embolism (PE), where a clot travels to the lungs. This scoring system is common in hospital settings, especially for patients preparing for or recovering from surgery. Developed by Dr. Joseph Caprini, the model has been validated in over 250,000 patients across more than 100 clinical studies. It provides a method for clinicians to evaluate a patient’s risk and guide preventative care.
How the Caprini Score is Calculated
The Caprini score is calculated by assigning points to specific risk factors related to a patient’s health. A healthcare provider adds these points to arrive at a final score, which correlates to a level of risk. The system accounts for a wide range of variables that could contribute to blood clot formation.
One-Point Factors
Factors that add one point to a patient’s score include:
- Being between the ages of 41 and 60
- Having a body mass index (BMI) over 25
- A history of varicose veins
- Undergoing a minor surgery with an anesthesia time of less than 45 minutes
- Current leg swelling or a history of inflammatory bowel disease
- Being pregnant or within one month postpartum
Two-Point Factors
Factors that add two points to a patient’s score include:
- Age falling between 61 and 74 years
- A history of cancer
- Undergoing a major surgery lasting more than 45 minutes
- Needing central venous access, which is a type of catheter placed in a large vein
Three-Point Factors
Factors that add three points to a patient’s score include:
- Being age 75 or older
- A personal history of a VTE or a known family history of blood clots
- A diagnosed inherited thrombophilia, a genetic condition that makes the blood more likely to clot
Five-Point Factors
Acute and severe conditions add five points to the score. These include:
- Experiencing a stroke or an acute spinal cord injury resulting in paralysis within the last month
- Undergoing elective major lower extremity surgery, such as a hip or knee replacement
- A recent hip, pelvis, or leg fracture within the past month
Understanding Your Score
Once all the points are tallied, the total Caprini score places a patient into a risk category. These categories provide a standardized interpretation of the score, helping healthcare teams understand the probability of a VTE event. The risk levels range from very low to the highest risk, with each step up representing an increase in the likelihood of developing a blood clot.
A score of 0 is the lowest risk, while a score of 1 to 2 places a patient in the low-risk category. In these ranges, the probability of developing a VTE is minimal. Patients with these scores have few, if any, recognized risk factors.
A score of 3 to 4 designates a patient as being at moderate risk. This indicates a notable chance of developing a blood clot if no preventative actions are taken. A patient in this category has accumulated several lower-point risk factors or at least one of the more significant ones.
A score of 5 or higher places a patient in the high-risk category. A score in this range means a patient has a combination of multiple risk factors, a history of clotting, or is undergoing a high-risk procedure. The chances of developing a clot grow as the numerical score rises.
Recommended Actions for Each Risk Level
Based on the calculated Caprini score and corresponding risk level, healthcare providers recommend specific preventative measures, known as prophylaxis. These actions range from simple physical activity to the use of medical devices and medications.
For patients in the very low and low-risk categories, with scores from 0 to 2, the primary recommendation is early and frequent ambulation. This means encouraging the patient to get out of bed and walk around as soon as possible after a procedure. The act of walking contracts leg muscles, which helps to circulate blood and prevent it from becoming stagnant in the veins of the lower legs.
Patients who fall into the moderate-risk category, with a score of 3 to 4, require more than just ambulation. Their preventative plan may include mechanical prophylaxis. This involves the use of devices like intermittent pneumatic compression (IPC) sleeves, which are cuffs that wrap around the legs and inflate and deflate to squeeze the muscles. Graduated compression stockings may also be used to apply gentle pressure and aid circulation.
For those at high risk, with a score of 5 or more, a combination of strategies is employed. These patients will be prescribed pharmacological prophylaxis, which involves anticoagulant medications, often called blood thinners. Commonly used medications include heparin or low-molecular-weight heparins. These are given alongside mechanical prophylaxis methods like IPC devices and compression stockings to provide protection against clot formation.