Caprini Score for VTE Risk
Select all risk factors present for your patient. Score ≥5 indicates high VTE risk requiring pharmacological + mechanical prophylaxis.
Age
+0Patient's age group
Surgery Type
+0Type of surgery if applicable
History of VTE
+5Previous deep vein thrombosis or pulmonary embolism
Family history of VTE
+3Family history of venous thromboembolism
Positive Factor V Leiden
+3Positive Factor V Leiden mutation
Prothrombin 20210A
+3Prothrombin G20210A mutation
Elevated serum homocysteine
+3Elevated serum homocysteine levels
Heparin-induced thrombocytopenia (HIT)
+3History of heparin-induced thrombocytopenia
Other thrombophilia
+3Other inherited or acquired thrombophilic conditions
Elevated anticardiolipin antibodies
+3Elevated anticardiolipin antibodies
Elevated lupus anticoagulant
+3Elevated lupus anticoagulant
Oral contraceptives or hormone replacement therapy
+1Current use of oral contraceptives or hormone replacement therapy
Pregnancy or postpartum
+1Currently pregnant or within postpartum period
History of unexplained stillborn infant, recurrent spontaneous abortion (≥3), premature birth with toxemia or growth-restricted infant
+1History of obstetric complications
Acute myocardial infarction
+1Recent acute myocardial infarction
Congestive heart failure (<1 month)
+1Congestive heart failure within the past month
Severe sepsis (<1 month)
+1Severe sepsis within the past month
Serious lung disease including pneumonia (<1 month)
+1Serious lung disease or pneumonia within the past month
Abnormal pulmonary function
+1Abnormal pulmonary function tests
Chronic obstructive pulmonary disease
+1Chronic obstructive pulmonary disease
Medical patient currently at bed rest
+1Medical patient currently on bed rest
Limb paralysis
+1Paralysis of one or more limbs
Recent plaster cast immobilization of lower extremity
+2Recent plaster cast immobilization of lower extremity
Central venous access
+2Presence of central venous catheter or access
Varicose veins
+1Presence of varicose veins
Inflammatory bowel disease
+1Active inflammatory bowel disease
Swollen legs (current)
+1Currently swollen legs
Obesity (BMI >25)
+1Body mass index greater than 25
Acute spinal cord injury (<1 month)
+5Acute spinal cord injury within the past month
Elective major lower extremity arthroplasty
+5Elective major lower extremity joint replacement
Hip, pelvis, or leg fracture (<1 month)
+5Hip, pelvis, or leg fracture within the past month
Stroke (<1 month)
+5Stroke within the past month
Multiple trauma (<1 month)
+5Multiple trauma within the past month
Major surgery (>45 min) with additional risk factors
+2Major surgery with additional risk factors present
Minor surgery with additional risk factors
+1Minor surgery with additional risk factors present
Caprini Score for VTE Risk
The Caprini Score is a comprehensive risk assessment tool used to evaluate the risk of venous thromboembolism (VTE) in both surgical and medical patients. It assigns points based on multiple risk factors and provides guidance for thromboprophylaxis.
Scoring Criteria
The Caprini Score evaluates various risk factors with different point values:
| Risk Factor | Points |
|---|---|
| Age 41-60 years | +1 |
| Age 61-74 years | +2 |
| Age ≥75 years | +3 |
| Minor surgery | +1 |
| Arthroscopic surgery | +2 |
| Major surgery (>45 min) | +2 |
| Laparoscopic surgery (>45 min) | +2 |
| Previous major surgery | +1 |
| History of VTE | +5 |
| Family history of VTE | +3 |
| Positive Factor V Leiden | +3 |
| Prothrombin 20210A | +3 |
| Elevated serum homocysteine | +3 |
| Heparin-induced thrombocytopenia (HIT) | +3 |
| Other thrombophilia | +3 |
| Elevated anticardiolipin antibodies | +3 |
| Elevated lupus anticoagulant | +3 |
| Oral contraceptives or hormone replacement therapy | +1 |
| Pregnancy or postpartum | +1 |
| History of unexplained stillborn infant, recurrent spontaneous abortion (≥3), premature birth with toxemia or growth-restricted infant | +1 |
| Acute myocardial infarction | +1 |
| Congestive heart failure (<1 month) | +1 |
| Severe sepsis (<1 month) | +1 |
| Serious lung disease including pneumonia (<1 month) | +1 |
| Abnormal pulmonary function | +1 |
| Chronic obstructive pulmonary disease | +1 |
| Medical patient currently at bed rest | +1 |
| Limb paralysis | +1 |
| Recent plaster cast immobilization of lower extremity | +2 |
| Central venous access | +2 |
| Varicose veins | +1 |
| Inflammatory bowel disease | +1 |
| Swollen legs (current) | +1 |
| Obesity (BMI >25) | +1 |
| Acute spinal cord injury (<1 month) | +5 |
| Elective major lower extremity arthroplasty | +5 |
| Hip, pelvis, or leg fracture (<1 month) | +5 |
| Stroke (<1 month) | +5 |
| Multiple trauma (<1 month) | +5 |
| Major surgery (>45 min) with additional risk factors | +2 |
| Minor surgery with additional risk factors | +1 |
Risk Stratification
| Score | Risk Level | VTE Risk | Recommended Prophylaxis |
|---|---|---|---|
| 0-1 | Very Low | 0.5% | Early ambulation |
| 2 | Low | 1.5% | Mechanical prophylaxis |
| 3-4 | Moderate | 3.0% | Pharmacological ± mechanical |
| ≥5 | High | 6.0% | Pharmacological + mechanical |
Clinical Application and Management
The Caprini Score helps guide thromboprophylaxis decisions:
- Very Low Risk (0-1 points):
- VTE risk is 0.5%
- Early ambulation is recommended
- No pharmacological prophylaxis needed
- Low Risk (2 points):
- VTE risk is 1.5%
- Mechanical prophylaxis recommended
- Consider graduated compression stockings
- Moderate Risk (3-4 points):
- VTE risk is 3.0%
- Pharmacological prophylaxis recommended
- Consider LMWH, fondaparinux, or UFH
- Mechanical prophylaxis may be used as adjunct
- High Risk (≥5 points):
- VTE risk is 6.0%
- Pharmacological + mechanical prophylaxis recommended
- Consider extended prophylaxis in certain cases
- Monitor for bleeding complications
Important Considerations
The Caprini Score should be used as part of a comprehensive clinical assessment:
- It is applicable to both surgical and medical patients
- Should be reassessed if patient condition changes
- Consider bleeding risk when prescribing thromboprophylaxis
- Individual patient factors may influence decision-making
- Follow institutional protocols and guidelines
- Consider extended prophylaxis for high-risk patients
Validation and Performance
The Caprini Score has been extensively validated:
- High sensitivity for identifying patients at risk
- Good specificity for low-risk patients
- Widely adopted in clinical practice
- Recommended by major guidelines
This tool has been widely adopted in clinical practice and is recommended by major guidelines for VTE prevention in surgical and medical patients.
References
- Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2-3):70-78.
- Caprini JA, Arcelus JI, Reyna JJ. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease. Semin Hematol. 2001;38(2 Suppl 5):12-19.
- Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-350.
- Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2_suppl):e227S-e277S.
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