Caprini Risk Score validity and prevention of venous thromboembolism in emergency surgery

Objective. To evaluate validity of the Caprini Risk Score (CRS) for predicting postoperative venous thromboembolism (VTE) in emergency surgery, as well as to investigate the impact of compliance with prophylactic protocols on the risk of postoperative thrombosis. Material and methods. A single-center prospective study included 267 patients after urgent or emergency major surgery. CRS scores were calculated before the intervention and at discharge. Routine mechanical and pharmacological prophylaxis for VTE was used after surgery. The primary endpoint was combination of asymptomatic and symptomatic deep vein thrombosis (DVT), identified with obligatory Doppler ultrasound before discharge, and pulmonary embolism (PE) verified by imaging or autopsy. Results. The incidence of postoperative VTE was 15.7% (95% CI, 11.8—20.6%), including two cases of PE (1 death). The number of VTE significantly correlated with final CRS score and increased from 2.3% in low-risk group to 55.6% in extremely high-risk group (V=0.509, p<0.001). CRS demonstrated high predictive ability: AUC=0.82 (95% CI, 0.76—0.89, p<0.001). The threshold was 5.5 scores with 81% sensitivity and 72% specificity. Compliance with the recommended anticoagulant dose was observed in 66% of patients. About 10% of patients received complete pharmacological and mechanical prophylaxis that did not affect the risk of postoperative VTE. In selective assessment, all patients with DVT had missed doses of heparins. Conclusion. The incidence of postoperative VTE in emergency surgery was 15.7% that correlated with CRS scores. Patients with CRS score ≥5 had a higher risk of complications.