Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis.

Abstract

OBJECTIVE:

We performed a meta-analysis to investigate benefits and harms of chemoprophylaxis among surgical patients individually risk stratified for venous thromboembolism (VTE) using Caprini scores.

SUMMARY OF BACKGROUND DATA:

Individualized VTE risk stratification may identify high risk surgical patients who benefit from peri-operative chemoprophylaxis.

METHODS:

MEDLINE, EMBASE, and the Cochrane Library (CENTRAL) databases were queried. Eligible studies contained data on postoperative VTE and/or bleeding events with and without chemoprophylaxis. Primary outcomes included rates of VTE and clinically relevant bleeding after surgical procedures, stratified by Caprini score. A meta-analysis was conducted using a random-effects model.

RESULTS:

Among 13 included studies, 11 (n = 14,776) contained data for VTE events and 8 (n = 7590) contained data for clinically relevant bleeding with and without chemoprophylaxis. The majority of patients received mechanical prophylaxis. A 14-fold variation in VTE risk (from 0.7% to 10.7%) was identified among surgical patients who did not receive chemoprophylaxis, and patients at increased levels of Caprini risk were significantly more likely to have VTE. Patients with Caprini scores of 7 to 8 [odds ratio (OR) 0.60, 95% confidence interval (95% CI) 0.37-0.97] and >8 (OR 0.41, 95% CI 0.26-0.65) had significant VTE risk reduction after surgery with chemoprophylaxis. Patients with Caprini scores ≤6 comprised 75% of the overall population, and these patients did not have a significant VTE risk reduction with chemoprophylaxis. No association between postoperative bleeding risk and Caprini score was identified.

CONCLUSIONS:

The benefit of peri-operative VTE chemoprophylaxis was only found among surgical patients with Caprini scores ≥7. Precision medicine using individualized VTE risk stratification helps ensure that chemoprophylaxis is used only in appropriate surgical patients and may minimize bleeding complications.

• Authors: Christopher J Pannucci, Lukasz Swistun, John K MacDonald, Peter K Henke, Benjamin S Brooke
• Journal: Annals of surgery (Ann Surg) Vol. 265 Issue 6 Pg. 1094-1103 (06 2017) ISSN: 1528-1140 [Electronic] United States
• PMID: 28106607 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Anticoagulants

Topics

• Anticoagulants (adverse effects, therapeutic use)
• Hemorrhage (chemically induced)
• Humans
• Postoperative Complications (prevention & control)
• Risk Assessment (methods)
• Venous Thromboembolism (prevention & control)