Key result
The Caprini-based risk assessment model classified 97.6% of medical inpatients as eligible for VTE prophylaxis, highly correlating with the Caprini model (ICC 0.932) and identifying more high-risk patients than the Padua model (52.9%).
Why the study?
The Caprini and Padua models assess VTE risk in surgical and medical patients respectively, but comparison of a hospital Caprini-based model to Caprini and Padua models in medical inpatients was needed.
Does the Caprini-based RAM accurately identify VTE risk and thromboprophylaxis eligibility compared to the Caprini and Padua RAMs in adult medical inpatients?
Cohort (n=297)
No
Does the Caprini-based RAM accurately identify VTE risk and thromboprophylaxis eligibility compared to the Caprini and Padua RAMs in adult medical inpatients?
Effect estimate: ICC 0.932 (95% CI 0.915-0.946)
Absolute Event Rate: 97.6% vs 52.9%
p-value: p=<0.001
The Caprini-based RAM identifies a significantly higher proportion of medical inpatients for VTE prophylaxis compared to the Padua RAM, without resulting in an increased risk of bleeding.
Should not yet change VTE prophylaxis practices; leaves open prospective outcome validation of Caprini-based RAM.
The Caprini and Padua venous thromboembolism (VTE) risk assessment models (RAMs) are used to assess VTE risk in surgical and in medical patients respectively. This study aims to compare the proportion of medical inpatients eligible for VTE prophylaxis using the hospital Caprini-based RAM to using the Caprini and Padua RAMs and to assess the associated clinical outcomes. In a prospective observational study, we assessed 297 adult medical inpatients for whom VTE thromboprophylaxis was initiated according to the hospital Caprini-based RAM, referred to as the Lebanese American University Medical Center RAM (LAUMC-RAM). The Padua, Caprini and IMPROVE bleeding risk scores were also assessed for all patients. Bleeding and thromboembolism were evaluated at 14 and 30 days post VTE risk assessment. Pharmacologic thromboprophylaxis was warranted in 97.6%, 99.7%, and 52.9% of patients using the Caprini-based, Caprini, and Padua RAMs respectively. The Caprini-based and Caprini RAMs were highly correlated (r = 0.873 p < 0.001) and were significantly less correlated with the Padua RAM. Major and overall bleeding occurred in 1.4% and 9.2% respectively. VTE was reported in 0.4% with no VTE related mortality. In hospitalized medical patients, the Caprini-based RAM can accurately distinguish low and high VTE risk without resulting in increased risk of bleeding.
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Chamoun et al. (2019) conducted a cohort in Medical inpatients requiring venous thromboembolism (VTE) risk assessment (n=297). Caprini-based VTE risk assessment model (LAUMC-RAM) vs. Padua and Caprini risk assessment models was evaluated on Proportion of patients considered at high risk for VTE and eligible for prophylaxis (ICC 0.932, 95% CI 0.915-0.946, p=<0.001). The Caprini-based risk assessment model classified 97.6% of medical inpatients as eligible for VTE prophylaxis, highly correlating with the Caprini model (ICC 0.932) and identifying more high-risk patients than the Padua model (52.9%).
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