Caprini Score

Summary / Explanation

Venous thromboembolism (VTE), which encompasses disorders such as deep vein thrombosis and pulmonary embolism, comprises a significant and frequently underdiagnosed complication among hospitalized patients. Despite its prevalence, VTE is largely preventable through appropriate risk assessment and targeted prophylactic interventions. Implementing standardized protocols for VTE prevention is essential to reduce its incidence and the associated morbidity and mortality.[1]

The Caprini Score

The Caprini Score is a validated risk assessment tool designed to estimate a patient’s likelihood of developing VTE. Originally developed in 1991 for surgical patients, the Caprini Score has since been updated multiple times, with the most recent comprehensive revision published in 2013. This predictive model assigns points to various risk factors related to the Virchow Triad—venous stasis, endothelial injury, and hypercoagulability—based on their presence currently or within the past month.[2] Notably, the Caprini Score uniquely includes family history of VTE and pregnancy loss as independent risk factors.

The 2013 Caprini Risk Assessment Model stratifies patients into 4 risk categories based on total points:

• Low risk: 0 to 1 point
• Moderate risk: 2 points
• High risk: 3 to 4 points
• Very high risk: at least 5 points

This stratification guides clinicians in tailoring VTE prophylaxis strategies according to individual patient risk (see Table. Caprini Risk Assessment Model 2013).[3] The classification incorporates a wide range of risk factors, such as age, recent surgery, malignancy, obesity (body mass index or BMI ≥25), smoking, insulin-dependent diabetes, chemotherapy, blood transfusions, and prolonged surgery duration (>2 hours). Female-specific factors include current hormone therapy and pregnancy-related risks.

Points from all applicable categories are added to calculate the total Caprini Score. Risk stratification and prophylaxis planning are determined based on the total score. Female-specific factors should be applied only to female patients where indicated.

Table. Caprini Risk Assessment Model 2013

Prophylaxis Recommendations Based on Risk Level

The Caprini Score informs decisions regarding VTE prevention but does not itself prescribe prophylaxis. Instead, this score estimates VTE risk, and prophylaxis is selected accordingly.

• Low risk (0-1 points): Early ambulation is generally sufficient. No pharmacologic or mechanical prophylaxis is typically required.

• Moderate risk (2 points): Mechanical prophylaxis (eg, intermittent pneumatic compression devices) or pharmacologic prophylaxis may be considered based on clinical context.

• High risk (3-4 points): Pharmacologic prophylaxis is recommended during hospitalization, with mechanical methods added if appropriate.

• Very high risk (≥5 points): Combined pharmacologic and mechanical prophylaxis is advised, often with extended pharmacologic prophylaxis postdischarge (7-10 days). In some cases, patients with scores above 8 may benefit from longer prophylaxis, usually up to 30 days.

Early identification of high-risk patients using the Caprini Score allows timely intervention with anticoagulant and mechanical prophylaxis. This approach not only improves acute outcomes but also helps prevent chronic complications that may occur even after appropriately treated acute VTE, such as recurrent VTE, postthrombotic syndrome, and chronic pulmonary hypertension.[4][5] Since prophylactic anticoagulation carries risks, particularly bleeding, accurate identification of patients who genuinely need prophylaxis is essential.

The Caprini Score must be regularly reassessed throughout hospitalization or postoperative recovery. Shifts in a patient’s clinical status may alter the total score, prompting adjustments in prophylactic management.

Clinical Impact and Validation

The Caprini Score has been validated internationally in over 5 million patients in more than 250 clinical trials. This tool helps identify individuals at risk for VTE, guiding timely, personalized prophylaxis that reduces VTE events and long-term complications. The integration of the Caprini Score into hospital protocols has led to measurable reductions in hospital-associated VTE and better patient outcomes.

Conclusion

The Caprini Risk Assessment Model is a validated method for evaluating VTE risk in hospitalized and surgical patients. By quantifying factors related to venous stasis, endothelial injury, and hypercoagulability, this system enables the interprofessional team to implement timely, risk-based prophylaxis. Routine use fosters coordinated care, enhances patient safety, and reduces preventable VTE-related morbidity and mortality across healthcare settings.