Pulmonary embolism assessment of probability of subsequent VTE and risk scores
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Venous thromboembolism (VTE) consists of deep vein thrombosis (DVT), pulmonary embolism (PE), or both. VTE is a disease associated with morbidity and mortality; therefore, VTE prophylaxis is indicated among specific categories of patients at elevated risk for VTE. Several scores have been developed for the assessment of risk of subsequent VTE such as the Padua prediction score and the IMPROVE score among hospitalized medically ill patients, and Roger's score and Caprini score among surgical patients.
Assessment of the Risk of Subsequent VTE in Medically Ill Patients
Padua Prediction Score for VTE
Calculation of the Padua Prediction Score
Shown below is a table depicting Padua predictive score for VTE among hospitalized medical patients.
| Variable | Score |
| Active cancer | 3 |
| Previous VTE | 3 |
| Decreased mobility | 3 |
| Thrombophilia | 3 |
| Previous trauma or surgery within that last month | 2 |
| Age≥ 70 | 1 |
| Heart and/or respiratory failure | 1 |
| Ischemic stroke or acute myocardial infarction | 1 |
| Acute rheumatologic disorder and/or acute infection | 1 |
| Obesity | 1 |
| Hormonal therapy | 1 |
Interpretation of the Padua Prediction Score
The interpretation of the score is as follows:
IMPROVE Predictive Score for VTE
Calculation of the IMPROVE Predictive Score
| Variable | Score[2] |
| Prior episode of VTE | 3 |
| Thrombophilia | 3 |
| Malignancy | 1 |
| Age more than 60 years | 1 |
Interpretation of the IMPROVE Predictive Score
| Score | Predicted VTE risk through 3 months[2] |
| 0 | 0.5% |
| 1 | 1.0% |
| 2 | 1.7% |
| 3 | 3.1% |
| 4 | 5.4% |
| 5-8 | 11% |
IMPROVE Associative Score for VTE
IMPROVE associative risk score assesses the risk of VTE among hospitalized medical patients. While the IMPROVE predictive score includes 4 independent risk factors for VTE which are present at admission, IMPROVE associative score includes 7 variables present either at admission or during hospitalization; however, the timing of the presence of some of the factors compared to the onset of VTE is not available.[2]
Calculation of the IMPROVE Associative Score
| Variable | Score[2] |
| Prior episode of VTE | 3 |
| Thrombophilia | 2 |
| Paralysis of the lower extremity during the hospitalization | 2 |
| Current malignancy | 2 |
| Immobilization for at least 7 days | 1 |
| ICU or CCU admission | 1 |
| Age more than 60 years | 1 |
Interpretation of the IMPROVE Associative Score
| Score | Predicted VTE risk through 3 months[2] |
| 0 | 0.4% |
| 1 | 0.6% |
| 2 | 1.0% |
| 3 | 1.7% |
| 4 | 2.9% |
| 5-10 | 7.2% |
Assessment of the Risk of Subsequent VTE in Surgery Patients
Rogers Score
Calculation of Rogers Score
| Variable | Score[3] |
| Pulmonary and hemic surgery | 9 |
| Thoracoabdominal aneurysm, embolectomy/thrombectomy, venous reconstruction, and endovascular repair surgery | 7 |
| Aneurysm surgery | 4 |
| Mouth or palate surgery | 4 |
| Stomach or intestines surgery | 4 |
| Integument surgery | 3 |
| Hernia surgery | 2 |
| American Society of Anesthesiologists (ASA) physical status classification 3, 4, or 5 | 2 |
| ASA physical status classification 2 | 1 |
| Female | 1 |
| Work relative value unit > 17 | 3 |
| Work relative value unit 10−17 | 2 |
| Disseminated malignancy | 2 |
| Chemotherapy for cancer in the last 30 days | 2 |
| Serum sodium > 145 mmol/L pre-op | 2 |
| Transfusion > 4 U packed red blood cells within 72 h pre-op | 2 |
| Dependency on ventilator | 2 |
| Wound class (clean/contaminated) | 1 |
| Hematocrit ≤ 38% pre-op | 1 |
| Bilirubin > 1.0 mg/dL pre-op | 1 |
| Dyspnea | 1 |
| Albumin ≤ 3.5 mg/dL | 1 |
| Emergency operation | 1 |
| ASA physical status classification 1 | 0 |
| Work relative value unit < 10 | 0 |
| Male | 0 |
Interpretation of Rogers Score
The Rogers score is calculated by adding the scores of all factors present in the patient. The Rogers score is interpreted in the following way:[3]
- Score 1-6: Low
- Score 7-10: Moderate
- Score > 10: High
Caprini Risk Assessment Model
Calculation of the Caprini Risk Score
Shown below is a table depicting the different scores for the factors included in the Caprini score.[4]
| 5 points | 3 points | 2 points | 1 point |
| ❑ Stroke (in the previous month) ❑ Fracture of the hip, pelvis, or leg ❑ Elective arthroplasty ❑ Acute spinal cord injury (in the previous month) |
❑ Age≥ 75 years ❑ Prior episodes of VTE ❑ Positive family history for VTE ❑ Prothrombin 20210 A ❑ Factor V Leiden ❑ Lupus anticoagulants ❑ Anticardiolipin antibodies ❑ High homocysteine in the blood ❑ Heparin induced thrombocytopenia ❑ Other congenital or acquired thrombophilia |
❑ Age: 61-74 years ❑ Arthroscopic surgery ❑ Laparoscopy lasting more than 45 minutes ❑ General surgery lasting more than 45 minutes ❑ Cancer ❑ Plaster cast ❑ Bed bound for more than 72 hours ❑ Central venous access |
❑ Age 41-60 years ❑ BMI > 25 Kg/m2 ❑ Minor surgery ❑ Edema in the lower extremities ❑ Varicose veins ❑ Pregnancy ❑ Post-partum ❑ Oral contraceptive ❑ Hormonal therapy ❑ Unexplained or recurrent abortion ❑ Sepsis (in the previous month) ❑ Serious lung disease such as pneumonia (in the previous month) ❑ Abnormal pulmonary function test ❑ Acute myocardial infarction ❑ Congestive heart failure (in the previous month) ❑ Bed rest ❑ Inflammatory bowel disease |
Interpretation of the Caprini Risk Score
The Caprini score is calculated by adding the scores of all factors present in the patient. The Caprini score is interpreted in the following way:[4][5]
- Score 0-1: Low risk of VTE
- Score 2: Moderate of VTE
- Score 3-4: High risk of VTE
- Score ≥ 5: Highest risk for VTE
References
- ↑ Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M; et al. (2010). "A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score". J Thromb Haemost. 8 (11): 2450–7. doi:10.1111/j.1538-7836.2010.04044.x. PMID 20738765.
- ↑ 2.0 2.1 2.2 2.3 2.4 Spyropoulos AC, Anderson FA, Fitzgerald G, Decousus H, Pini M, Chong BH; et al. (2011). "Predictive and associative models to identify hospitalized medical patients at risk for VTE". Chest. 140 (3): 706–14. doi:10.1378/chest.10-1944. PMID 21436241.
- ↑ 3.0 3.1 Rogers SO, Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF (2007). "Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study". J Am Coll Surg. 204 (6): 1211–21. doi:10.1016/j.jamcollsurg.2007.02.072. PMID 17544079.
- ↑ 4.0 4.1 Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F (1991). "Clinical assessment of venous thromboembolic risk in surgical patients". Semin Thromb Hemost. 17 Suppl 3: 304–12. PMID 1754886.
- ↑ Caprini JA (2005). "Thrombosis risk assessment as a guide to quality patient care". Dis Mon. 51 (2–3): 70–8. doi:10.1016/j.disamonth.2005.02.003. PMID 15900257.