Key result
Caprini score fails to predict VTE risk following primary joint arthroplasty when controlling for prophylaxis.
Why the study?
The Caprini score is used to assess VTE risk, but its ability to predict VTE incidence and guide prophylaxis after primary joint arthroplasty is uncertain.
Does the Caprini score predict VTE incidence and guide pharmacologic prophylaxis after primary joint arthroplasty?
Cohort (n=2,155)
Single-blind
No
Does the Caprini score predict VTE incidence and guide pharmacologic prophylaxis after primary joint arthroplasty?
Effect estimate: Cohen's d = 0.25 (Aspirin), d = 0.16 (other)
p-value: p=0.16
The Caprini score had a small effect size and lacked the predictive power necessary to guide VTE prophylaxis after primary lower extremity total joint arthroplasty.
Caprini score lacks predictive power for post-TJA VTE; leaves open need for validated, TJA-specific risk tools in prospective studies.
AIMS: Venous thromboembolism (VTE) has a 30-day mortality rate of between 10 and 30%. The Caprini score is a VTE risk assessment model, which assigns points to 20 past medical history and current health factors. We hypothesized that the Caprini score could predict VTE incidence and recommend prophylaxis following total joint arthroplasty. PATIENTS AND METHODS: We performed a retrospective review of prospectively collected institutional data identifying Caprini scores on 2155 primary hip (n = 840) and knee (n = 1315) arthroplasties. Surgeons were blinded to Caprini scores when prescribing VTE prophylaxis. Patients were separated into prophylaxis groups receiving Aspirin (81 mg BID or 325 mg BID) or other (Rivaroxaban, Warfarin, Enoxaparin, Apixaban, Dabigatran, Heparin). Univariate, multivariate, and Cohen's effect size analyses assessed the predictive power of the Caprini score on VTE incidence. RESULTS: The mean Caprini score was 9.49 (5-25). A majority, 83% (1792) of patients were in the Aspirin group, and 17% (363) in the other group. Other prophylaxis patients had statistically significantly higher Caprini scores (10 vs. 9, p < 0.0001). Twenty-five (1.2%) patients developed VTE. Controlling for prophylaxis, higher Caprini scores increased VTE risk, but this wasn't statistically significant (p = 0.16). Multivariate analysis showed a non-significant effect for patients with BMIs >40 or Caprini scores ≥11 to predict VTE incidence in the Aspirin or other prophylaxis groups (p = 0.52 and p = 0.15 respectively). Cohen's effect size was small, comparing Caprini scores in patients who had and had not had a VTE in both Aspirin and other prophylaxis groups (Cohen's d = 0.25 and d = 0.16 respectively). CONCLUSION: Surgeons rely on stronger pharmacologic prophylaxis for a select high risk group of their primary lower extremity total joint arthroplasty patients. When controlling for prophylaxis, the Caprini score had a small effect size and did not have the predictive power necessary to guide treatment.
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Gold et al. (2020) conducted a cohort in Primary joint arthroplasty (n=2,155). Caprini score was evaluated on VTE incidence (Cohen's d = 0.25 (Aspirin), d = 0.16 (other), p=0.16). When controlling for prophylaxis, the Caprini score did not significantly predict VTE incidence following primary joint arthroplasty (p=0.16) and had a small effect size.
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