Assessing risk factors for the development of Venous Thromboembolism

(VTE) in surgical patients using Adapted Caprini Scoring System

DATE:
Name :
Age
:
Gender:
M
F
Height : ..meters. Weight:
kg
IP No. :

Date of Admission:
Date of Discharge :
Phone No. 1:
Phone No. 2:
Elective Surgery

UNIT:

Emergency Surgery

(TICK/ FILL the appropriate boxes)

Diagnosis at Admission:

Surgery planned:

Diagnosis at Discharge :

Surgery done:

1 point each:

Age 41-60 years

Minor surgery planned

(< 45 min)

H/o prior major surgery

(<1 month)

Day1

72hr/dischar
ge

Day1

2 points each:

72hr/discharge

Age 60-70 years

Malignancy (present or previous)
Major surgery (>45 minutes)

Varicose veins
H/o inflammatory bowel
disease

Swollen legs (current)

Obesity (BMI>25 kg/m2)

Acute myocardial
infarction
Congestive cardiac failure
(<1 month)

Sepsis (<1 month)

Serious lung disease,

pneumonia (<1 month)

Abnormal pulmonary
function (COPD)

Laparoscopic surgery (>45 minutes)

Patient confined to bed (>72 hours)
Immobilising plaster cast (<1 month)
Central venous access

TOTAL
3 points each:

Age >75 years

H/O DVT/PE
Family h/o thrombosis
Heparin induced thrombocytopenia
Congenital or acquired thrombophilia

Medical patient currently

at bed-rest

TOTAL
5 points each:
Elective major lower extremity arthroplasty

TOTAL

Hip /pelvis / leg fracture (<1 month)

For women only, 1 point each:

Stroke (<1 month)

OCPs or HRT

H/o multiple trauma (<1 month)

Pregnancy or postpartum <1

month

Acute spinal cord injury (paralysis) (<1m)

H/o
unexplained
stillborn
infant, recurrent spontaneous

TOTAL

Adapted Caprini Score at 72 hours/ At

discharge:
Page
1
P.T.O

abortions >= 3, premature birth

with toxaemia or growth
restricted infant

TOTAL

Adapted Caprini Score

Day 1:

VTE PROFILE

Page 2

VTE detected

VTE detected on:

DVT Symptoms/ signs (More than one can be ticked)

As inpatient

1.

Swelling of the leg or along a vein in

the leg

2.

Pain or tenderness in the leg, which

you may feel only when standing or
walking

3.

Increased warmth in the area of the

leg that's swollen or painful

4.

Red or discoloured skin on the leg

Day 3

After discharge

Day 7
Day 14
Day 30

Pulmonary Edema symptoms/signs (More than one

Day 3

can be ticked)

Day 7

DVT prophylaxis

1.

Unexplained shortness of breath

2.

Pain with deep breathing

3.

Coughing up blood

Day 14
Day 30

Received

Drug formulation .

not received

Dosage ..
Route

VTE confirmed by
Complications of VTE

Complications due to
DVT Prophylaxis

Mortality

Duplex USG (DVT)

CT Angiogram (PE)

Complications due to DVT

Complications due to PE

Minor

Major

HIT

Inpatient/ after discharge

Attributed to VTE( state reason)

Day after surgery

YES

ICU/ HDU/ WARD

NO

Sudden Death YES/ NO

OTHER DETAILS
Exclusion Criteria:
1.

Patients diagnosed to have VTE at admission

2.

Patient on anticoagulation therapy for any reason

3.
4.

5.

Patients planned for lower limb vascular

interventions/ vascular surgery

6.

Patients with clear indication for therapeutic

anticoagulation

7.

Patients in whom anticoagulants are

contraindicated (bleeding disorder,

thrombocytopenia)

Page 2

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