Predictive value of three kinds of thrombosis risk assessment scale for lower extremity deep vein thrombosis after hip fracture in elderly patients / 中国骨伤

OBJECTIVE@#To explore predictive value of Caprini score, Wells score and Autar score for lower extremity deep vein thrombosis (DVT) after hip fracture in elderly patients.@*METHODS@#A total of 310 elderly patients with hip fracture were selected from January 2018 to September 2022. According to the lower extremity color ultrasound examination results, 155 patients with DVT were divided into thrombosis group, included 42 males and 113 females, aged from 60 to 101 years old with an average of (80.58±8.84) years old; and 155 patients without DVT were divided into control group, included 58 males and 97 females, aged from 60 to 94 years old with an average of (79.01±8.99) years old. Caprini score, Wells score and Autar score immediately after admission were collected and compared between two groups. Receiver operating characteristic (ROC) curve was used to evaluate predictive value of three thrombus risk assessment tables for DVT after hip fracture in elderly patients.@*RESULTS@#Caprini score, Wells score and Autar score in thrombus group were significantly higher than those in control group (P<0.001). ROC curve analysis results showed that the best cut-off value of Caprini score was 8.5 points, the sensitivity was 46.5%, the specificity was 99.4%, and area under the curve(AUC) was 0.763. The best cut-off value of Wells score was 1.5, the sensitivity was 100%, the specificity was 99.4%, and AUC was 0.998. The best cut-off value of Autar score was 10.5 points, the sensitivity was 58.1%, the specificity was 84.5%, and AUC was 0.717.@*CONCLUSION@#Caprini scale, Wells scale and Autar scale all have good predictive efficacy for the risk of DVT in elderly patients with hip fracture, and could provide an important reference for clinical guidance for prevention, management and treatment of DVT after hip fracture in elderly patients, among which Wells scale has a higher predictive value.

Risk assessment of venous thromboembolism in emergency patients in Beijing / 中华急诊医学杂志

Objective:To assess the risk of venous thromboembolism (VTE) and anticoagulation-related bleeding of acute critical emergency patients staying in the emergency department at least 72 h, so as to improve the ability of emergency physicians to identify risk factors of VTE and their awareness of safety prevention in these patients.Methods:Multicenter emergency internal medicine patients meeting the inclusion criteria at the same time were collected. Padua and Caprini scores were used to evaluate the risk of VTE and the HAS-BLED score was used to assess the risk of anticoagulation-related bleeding.Results:A total of 930 emergency patients from 7 medical centers were enrolled in our study from January 15, 2021 to March 15, 2021. The proportion of high-risk population with VTE was 50.22% with Padua score and 78.49% with Caprini score, respectively. The proportion of high-risk bleeding (HAS-BLED score) was 40.43%.Conclusions:More than half of the acute critical ill patients who stay in emergency department for more than 72 h are at high risk of VTE. This group of patients have a relatively low risk of anticoagulation-related bleeding.

Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study / 中国骨伤

OBJECTIVE@#To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).@*METHODS@#A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group, and 172 patients without DVT after TKA in the same period according to the 1∶4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data, score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model.@*RESULTS@#The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12), P<0.001];DVT group was mainly at medium and high risk group(66.67%), while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI≥30 kg/m2, lower extremity edema (<1 month), severe pulmonary disease (<1 month), acute myocardial infarction (<1 month), bed rest (> 2 h), history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380), BMI≥30 kg/m2(OR=2.518), lower extremity edema(<1 month)(OR=7.652), acute myocardial infarction (<1 month) (OR=1.994), bed rest (> 72 h)(OR=3.897), history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification, respectively.@*CONCLUSION@#Caprini MRAM can be used to predict the risk of DVT in patients after TKA, especially for patients with high risk.

Study of hospitalization risk indicators for intensive care unit patients evaluated by intelligent calculation method / 中华危重病急救医学

Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.

Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

Background. Venous thromboembolism (VTE) is regarded as the most preventable cause of inpatient death in hospital settings globally. VTE can be prevented through the provision of non-pharmacological and/or pharmacological thromboprophylaxis following individualised risk screening. The Caprini risk assessment model (RAM) offers a validated and well-established approach for VTE risk assessment in medical inpatients. Literature findings describe a trend towards inappropriate and under-prescribing of thromboprophylaxis in this population. Together with concerns regarding clinicians' perceived importance of VTE risk assessment, the need to clarify these aspects of practice is evident. Objectives. To describe VTE risk assessment and prophylaxis practices of medical practitioners in public sector hospitals in Western Cape Province, South Africa (SA). Methods. A retrospective, cross-sectional study design was employed in the medical wards of two district hospitals and one regional hospital in the Cape Town metropole, Western Cape. Medical folders of adult medical inpatients admitted between January and July 2020 were reviewed to assess VTE risk using the Caprini RAM. Thromboprophylaxis therapy prescribed and contraindications to chemoprophylaxis were also evaluated. Results. Of 380 patients included in the review, 51.6% were female, and the average age was 52.1 years (range 18 - 96); 21.3% had their weight recorded, while none had their height documented. Infectious disease was the predominant diagnosis (49.2%) detected in the sample. Common VTE risk factors identified included bed rest/restricted mobility for <72 hours (76.3%) and serious infection (67.4%). A total of 97.1% of patients (n=369) were found to be at moderate or higher risk of VTE (Caprini score ≥2). Of this at-risk group, 24.1% were eligible to receive chemoprophylaxis, yet no prescription for thromboprophylaxis was identified. Seventy percent of patients (n=266) were prescribed chemoprophylaxis, with enoxaparin accounting for 98.5% of regimens. Contraindications to chemoprophylaxis were recorded in 13.4% of patients. Conclusions. Although rates of VTE prophylaxis in medical inpatients may be improving, thromboprophylaxis still remains critically underutilised in this population. This study highlighted a consequence of this trend, with inappropriate chemoprophylaxis prescribing becoming more evident. Mechanical prophylaxis prescribing in medical inpatients is lacking, despite the associated benefits. RAMs should be adapted for the SA setting, where infectious diseases are prevalent. Future research should assess RAM use by clinicians, as this could provide insight into improving RAM uptake and thromboprophylaxis prescribing.

The combination of thrombotic biomarkers and Caprini score to predict the risk of deep vein thrombosis after traumatic lower extremity fractures / 中华检验医学杂志

Objective:To seek indicators or models for predicting the risk of deep vein thrombosis (DVT) after traumatic lower extremity fractures.Methods:A nested case-control study was conducted on 424 patients with traumatic lower extremity fractures in Beijing Jishuitan Hospital from May 2019 to December 2019. Patients with traumatic lower extremity fractures of the hip, femoral shaft, distal femoral, patella, tibial plateau, tibiofibular shaft, ankle or foot were 18 or older. Trauma patients were examined by venogram before surgery. 56 of 424 patients with traumatic lower limb fractures were diagnosed with preoperative DVT. Then, those with no evidence of DVT were paired by age, gender and fracture sites to those with DVT. Laboratory parameters included conventional coagulation tests and thrombotic biomarkers, such as D-dimer, plasmin-ɑ2-plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (tPAIC), and Caprini score was calculated. Univariate analysis was used to distinguish statistically significant variables between trauma patients with and without DVT. Then logistic regression analysis was applied to identify independent risk factors for post-traumatic DVT. The receiver-operating characteristic (ROC) curve analysis was employed to assess the efficacy of indicators in predicting the risk of DVT after traumatic lower extremity fractures.Results:The levels of tPAIC and Caprini score in patients with DVT after traumatic lower limb fractures were significantly higher than those in non-DVT patients ( P values of 0.036 and 0.016, respectively). D-dimer, PIC, and Caprini score were independent risk factors for preoperative DVT after traumatic lower limb fractures. Thus, we defined the Predicting Index as 0.098×D-dimer (mg/L FEU)+(-0.564) ×PIC (μg/ml)+0.233×Caprini score, and found that the area under the ROC curve for the Predicting Index was 0.721. Conclusions:Predicting Index, calculated by D-dimer, PIC and Caprini score, can comprehensively encompass the changes of risk factors between patients with and without DVT after traumatic lower limb fractures, and can well predict the risk of DVT after traumatic lower extremity fractures.

Caprini model for prevention of venous thromboembolism in coma patients after surgery for severe traumatic brain injury / 中国基层医药

Objective:To analyze the preventive effect of Caprini model on venous thromboembolism (VTE) in coma patients after severe craniocerebral trauma.Methods:A total of 190 patients with severe craniocerebral trauma who received treatment in Lishui City People's Hospital, China between January 2015 and April 2019 were randomly divided into a control group and an observation group ( n = 95/group). Patients in the control group underwent the conventional strategy to prevent lower extremity VTE. Patients in the observation group were subjected to individualized strategies to prevent lower extremity VTE based on Caprini model assessment. The drop-out rate and treatment outcome were compared between the control and observation groups. The proportion of patients developing VTE during treatment in Department of Intensive Care Unit and the changes in coagulation indexes relative to before treatment were compared between the two groups. Results:There was no significant difference in drop-out rate between the control and observation group [10.53% (10/95) vs. 8.42% (8/95), χ2 = 0.245, P < 0.05]. The proportion of patients developing VTE in the observation group was significantly lower than that in the control group [2.30% (2/87) vs. 10.59% (9/85), χ2 = 4.935, P < 0.05]. At 7 days after surgery, the coagulation indices D-dimer, platelet count, prothrombin time, activated partial thromboplastin time in the observation group were (2.27 ± 0.43) mg/L, (281.62 ± 37.29) × 10 9/L, (12.93 ± 2.87) seconds and (34.35 ± 7.19) seconds, respectively, which were (3.31 ± 0.68) mg/L, (303.28 ± 39.96) × 10 9/L, (11.24 ± 2.46) seconds and (31.16 ± 6.82) seconds, respectively in the control group. The coagulation indices in the observation group were significantly superior to those in the control group ( t = 10.013, 3.070, -3.463, -2.493, all P < 0.05). Conclusion:The Caprini model is effective in preventing VTE in patients with coma after surgery for severe traumatic brain injury. It deserves to be clinically applied.

Analysis of Influencing Factors for Postoperative Venous Thromboembolism of Thymic Malignancies / 中国肺癌杂志

BACKGROUND@#The previous study has indicated that the incidence of venous thromboembolism (VTE) after thoracic surgery is high. The purpose of this study was to analyze the incidence and risk factors of postoperative VTE in thymic malignancy patients.@*METHODS@#This was a single-center study. Patients undergoing resection for thymic malignancy between December 2017 and February 2021 in Department of Thoracic Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled in this study. In addition to the routine examination, all patients were screened for deep venous thrombosis (DVT) by using noninvasive duplex lower extremity ultrasound before and after surgery. Patients did not receive any prophylactic anticoagulant therapy before and after surgery. All patients received modified caprini risk assessment. According to whether VTE occurred after operation, patients were divided into VTE group and control group. The clinical data of the two groups were compared. The occurrence time and possible high risk factors of VTE after operation were analyzed.@*RESULTS@#A total of 169 patients with thymic malignant tumor were enrolled, including 94 males and 75 females, aging from 22 to 76 years. A total of 95 patients underwent thoracoscopic surgery and 74 patients underwent median sternotomy. The total incidence of VTE was 12.4%. The median time for diagnosis of VTE was 4 days (2 days-15 days) after operation. According to the modified caprini score, the incidence of VTE in low risk patients (Caprini score≤4 points), moderate risk patients (Caprini score 5 to 8 points) and high risk patients (Caprini score≥9 points) were 0% (0/7), 7.0% (8/115) and 27.7% (13/47), respectively (Z=1.670, P=0.008). Univariate analysis showed that there were significant differences between VTE group and control group in age, operation method, operation time, indwelling central venous catheter, postoperative bed rest time more than 72 hours (P<0.05). Multivariate analysis showed that over 60 years old, operation method and operation time were independent risk factors for VTE after resection for thymic malignancies.@*CONCLUSIONS@#Over 60 years old, operation method and operation time are independent risk factors for VTE. Modified caprini assessment can effectively screen high-risk patients.

Enfermedad tromboembólica venosa: factores de riesgo y profilaxis en pacientes hospitalizados / Venous thromboembolic disease: risk factors and prophylaxis in hospitalized patients

Un alto porcentaje de pacientes hospitalizados puede presentar trombosis venosa profunda con sus corresponientes consecuencias. Objetivos: Determinar el riesgo y tratamiento profiláctico de enfermedad tromboembólica venosa (ETEV) en pacientes hospitalizados. Métodos:investigación de tipo observacional, transversal y multicéntrica. Se aplicó la escala de Caprini para identificar factores de riesgo en pacientes hospitalizados de cuatro hospitales del área Metropolitana de Caracas. Por otra parte, se aplicó una encuesta a médicos residentes y especialistas de las distintas sedes hospitalarias para determinar su conocimiento en profilaxis para ETEV. Resultados: Se registraron 851 pacientes hospitalizados con edad 48,6 + 19,3 años, con predominio del género masculino (59 %). Estaban en servicios quirúrgicos 489 pacientes (57,5 %) y servicios médicos 362 pacientes (42,5 %). Según la escala de Caprini 154 pacientes (18,1 %) estaban en riesgo moderado, y 642 pacientes (75,4 %) en riesgo alto. Recibieron tratamiento profiláctico 61 pacientes (7,7 %), siendo la medicación y la dosis adecuada solo en el 32,8 % de estos pacientes. En cuanto al conocimiento de ETEV, el 96,9 % de los médicos conoce la enfermedad, pero solo el 58,5 % reconoce la embolia pulmonar como parte de esta entidad. Solo el 49,2 % de los encuestados conoce o aplica escalas de riesgo para esta enfermedad. El tratamiento farmacológico es conocido por el 93,8 % de los médicos. Solo el 56,6 % de los médicos realiza seguimiento a los pacientes, siendo el lapso menor de 3 meses el más frecuente (40 %). Conclusiones: en nuestro estudio hay predominio de pacientes con alto riesgo para ETEV. El uso de profilaxis farmacológica es muy bajo. El conocimiento de escalas de riesgo no es adecuado(AU)

Venous thromboembolic disease is frequent in hospitalized patients.Objectives: To determine the risk and prophylactic therapy of venous thromboembolic disease (VTE) in patients with medical and surgical pathologies according to the Caprini scale. Methods: an observational, transversal and multicenter research was performed. The Caprini scale was applied to identify risk factors in medical and surgical hospitalized patients of four hospitals in the metropolitan area of Caracas. Also, a survey was applied to residents and specialists from the different hospitals to determine the knowledge about prophylactic treatment for VTE. Results: we registered 851 hospitalized patients with an age of 48,6 + 19,3 years, mainly men (59 %). There were 489 surgical patients (57,5 %) and 362 medical patients (42,5 %). According to Caprini risk scale 154 patients (18,1 %) were at middle risk and 642 patients (75,4 %) were at high risk. Prophylactic treatment was indicated in 61 patients (7,7 %), this treatment was adequate (doses and drug type) only in 32 % of these patients. About the ETV, 96,9 % of the medical doctors had knowledge of this illness, but only 58,5 % recognize pulmonary embolism as part of this entity. Only 49,2 % knows or applies risk scales for ETV. 56,6 % follows the patients, more frequently for less of 3 months (40 %). Conclusions: we found is a high predominance of moderate to high risk patients for ETV. Pharmacological prophylaxis was very low. ETV risk scales knowlegde is not adequate(AU)

Determinación del riesgo de tromboembolismo pulmonar y trombosis venosa profunda en pacientes hospitalizados en un servicio de medicina interna / Determination of the risk of lung thromboembolism and deep venous thrombosis in patients hospitalized in an internal medicine service

Objetivo General: Determinar el riesgo de Tromboembolismo pulmonar (TEP) y Trombosis venosa profunda (TVP) en un grupo pacientes con patologías médicas. Métodos: Se realizó un estudio, unicéntrico, descriptivo, longitudinal, en pacientes > 18 años, ingresados por un periodo mayor de 72 horas en el servicio de medicina interna del Hospital Central del IVSS "Dr. Miguel Pérez Carreño", aplicando los modelos de evaluación de riesgos de Padua y Caprini. Resultados: La muestra estuvo representada por 114, el promedio de edad fue de 51 años ± 23, de mayoría femenino con 55 %, el principal diagnóstico de ingreso hospitalario, fue de origen infeccioso con 42,2 %. La escala Padua clasificó como bajo riesgo al 88,6 % y Caprini en alto riesgo al 36,8 %. El primer factor de riesgo fue la edad > 40 años con 82,46 %. El 3,51% de los pacientes presentaron un evento tromboembólico, teniendo positividad en el Dímero D con una media de 733,7 ± 181,3, al igual el eco-doppler venoso y en el caso de TEP, el angiotac pulmonar evidenció trombo de la rama derecha de la arteria pulmonar. Los dos factores de riesgo en este grupo estuvo dado por la edad (>65 años) y tasa de filtración glomerular <90 mL/min/1.73m2. El modelo de evaluación de riesgos de Padua presentó mayor capacidad predictiva (p < 0,05). Conclusión: La presencia de ETEV fue baja, a pesar que la muestra evaluada presentaba factores de riesgo y sin terapia trombo profiláctica, que evidencia la necesidad de evaluar los modelos de riesgos en pacientes con patologías médicas hospitalizados

General Objective: To determine the risk of pulmonary thromboembolism (PET) and deep vein thrombosis (DVT) in a group of patients with medical pathologies. Methods: A longitudinal, descriptive, single-center study was conducted in patients > 18 years, admitted for a period of more than 72 hours in the internal medicine service of the Central Hospital of the IVSS "Dr. Miguel Pérez Carreño", applying the Padua and Caprini risk assessment models. Results: The sample was represented by 114, the average age was 51 years ± 23, mostly female with 55 %, the main diagnosis of hospital admission, was of infectious origin with 42,2 %. The Padua scale classified 88,6 % as low risk and Caprini as high risk 36.8 %. The first risk factor was age > 40 years with 82,46 %. 3,51% of the patients presented a thromboembolic event, having a D-Dimer positivity with a mean of 733,7 ± 181,3, like venous echo-Doppler and, in the case of PET, pulmonary angiotac showed thrombus of the right branch of the pulmonary artery. The two risk factors for this group were given by age (> 65 years) and glomerular filtration rate <90 mL / min / 1.73m2. The Padua risk assessment model showed greater predictive capacity (p < 0.05). Conclusion: The presence of VTE was low, despite the fact that the sample evaluated presented risk factors and without thromboprophylactic therapy, which shows the need to evaluate the risk models in patients with hospitalized medical conditions

Perioperative Venous Thromboembolism (VTE) Prophylaxis in Thoracic Cancer Patients: Chinese Experts Consensus - Interpretation of Screening of High-risk Patients / 中国肺癌杂志

Venous thromboembolism (VTE) is a common perioperative complication in patients with thoracic malignant tumor. Once it occurs, it will not only affect the prognosis of patients, but also occupy a lot of medical resources, which is gradually causing our widespread attention. However, the understanding of VTE in thoracic surgery in our country is relatively late, and the recognition and attention are not enough, and there is still a lack of guidance support for perioperative VTE. Based on the current understanding and preventive measures of VTE in thoracic surgery in China, The China National Research Collaborative Group released the first edition of Chinese experts consensus on the perioperative VTE prophylaxis in 2018. This article will interpret the high-risk patients with perioperative VTE in patients with thoracic malignant tumors, in order to provide a better understanding of Chinese experts consensus for readers.

Evaluation of D-dimer for monitoring venous thromboembolism risk during short-term in hospitalized cancer patients without surgery / 临床检验杂志

Objective@#To assess the value of D-dimer for monitoring venous thromboembolism risk in hospitalized non-surgical cancer patients within 15 days. @*Methods@#A total of 397 non-surgical cancer patients from January 2018 to December 2018 were enrolled, including 236 males and 161 females in the age of (56±18) years. According to Caprini Thrombosis Risk Scale, the patients were divided into 2 groups: the intermediate-risk group (171 patients, 3 to 4 points) and the high-risk group (226 patients, ≥5 points). The plasma levels of D-dimer were determined by using the Biomerieux Mini Vidas Automated Immunoassay Analyzer and VADIS D-Dimer Exclusion. The enrolled patients were followed up for 15 days with the endpoint event of VTE. The experimental data were expressed by M (P 25 , P 75 ). The Mann-Whitney U test was used to compare the data between the two groups. The Kaplan-Meier curve was used to implement the survival analysis. P＜0.05 was considered as statistically significance. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of D-dimer. @*Results@#The plasma level of D-dimer in the high-risk group were significantly higher than that in the intermediate risk group (U=13 306, P＜0.001). There was no significant difference for the incidence of VTE between the two groups (χ 2 =1.85, P＞0.05). When the cut-off point value of D-dimer was defined as 1 579 ng/mL, the sensitivity of VTE risk prediction in cancer patients within 15 days was 69.0%, the specificity was 57.1% and the area under the ROC curve was 0.694 (95% CI: 0.613-0.774). There were significant differences in Caprini scores between the patients with D-dimer ≤1 579 ng/mL and D-dimer＞1 579 ng/mL (U=16 104，P=0.002). There was no statistical difference for the incidence of VTE between the two groups (χ 2 =7.36, P＞0.05). Among all of the patients, the patients with D-dimer＞1 579 ng/mL showed significantly higher cumulative probability of VTE within 15 days, compared with patients with D-dimer≤1 579 ng/mL (Log-rank χ 2 =7.729, P=0.005). In the intermediate-risk group, the cumulative probability of VTE of the patients whose D-dimer plasma level above the cut-off point value within 15 days was significantly higher than that of the patients with D-dimer plasma level below the cut-off point value (Log-rank χ 2 =7.156，P=0.007). In the high-risk group, there was no significant difference in the cumulative probability of VTE between the patients with D-dimer plasma level above the cut-off point value and the patients below the cut-off point value (Log-rank χ 2 =2.009，P=0.156). @*Conclusion@#According to the Caprini rating scale or D-dimer cut-off point value (1 579 ng/mL), cancer patients could be divided into two groups: VTE intermediate-risk and VTE high-risk. There were no significant differences in the two groups for the incidence of VTE within 15 days. However, the cumulative probability of VTE was significantly increased in total patients of both groups monitored by D-dimer, and the VTE cumulative probability in intermediate-risk group patients was increased.

The changes of Caprini score, D-D and FIB levels in post-fracture DVT patients and their diagnostic significance / 临床外科杂志

Objective To investigate the changes of Caprini score, plasma D-D and FIB levels in patients with post-fracture DVT and its diagnostic significance.Methods Sixty patients with post-fracture DVT (DVT group) and 120 patients without DVT after fracture were selected (control group).The Caprini score, plasma D-D and FIB levels were compared between the two groups.The relationship between Caprini score and plasma D-D and FIB in the DVT group was analyzed.Results The Caprini score, D-D and FIB levels in the DVT group[7.26±1.88, (3.31±1.52) mg/L, (4.48±0.72) g/L] were significantly higher than those in the control group[3.39±0.80, (0.46±0.11) mg/L, (3.60±0.68) g/L], and the difference was statistically significant (P＜0.05).There was a significant positive correlation between Caprini score and D-D and FIB levels in patients with DVT (P＜0.05).There was a positive correlation between Caprini score and level of D-D and FIB (r=0.748、r=0.662, P＜0.05).The sensitivity of Caprini score combined with D-D and FIB levels in the diagnosis of DVT in fracture patients was 97.83％, specificity was 92.00％, missed diagnosis rate was 2.17％, misdiagnosis rate was 8.00, and area under ROC curve was 0.947 (P＜0.05).Conclusion Caprini score, D-D and FIB levels in patients with lower limb fracture have certain clinical value for the diagnosis of DVT.

The value of Caprini thrombosis risk assessment in postoperative patients with lung cancer / 中国实用护理杂志

Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE). Methods A retrospective analysis of 136 patients with postoperative lung cancer who were admitted to our department between October 2015 and October 2017 was followed up for 2 months. According to the follow-up results, the patients were divided into VTE group and non-VTE group. The VTE group was further divided into the PE group and the deep venous thrombosis (DVT) group according to the embolization type. Comparisons were made between the two groups for general clinical data, surgically related parameters, and differences in Caprini scores. Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model. Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE. Results There were 39 cases in VTE group and 97 cases in non-VTE group. Among them, 28.2% (11/39) of VTE events occurred after discharge. The hospitalization time and Caprini risk scores in VTE group were (16.3±3.6) days, (10.5±2.4) points, which were significantly higher than (8.9±3.4) days, (9.3±2.1) points in non-VTE group (t=11.287, 2.891, P<0.01). In the VTE event, the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant. It was worse than DVT group (P<0.05). When Caprini's high-risk risk cut-off was 9 points, the accuracy was 76.5%, the positive predictive value was 58.1%, the negative predictive value was 84.9%, and the sensitivity and specificity were 64.1% and 81.4% , respectively. Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01), varices (P<0.01), sepsis (P<0.01), and severe acute lung disease (P<0.01). Congestive heart failure (P<0.01), central venous catheter (P<0.01), and VTE history (P<0.01) were all independent risk factors associated with VTE events. The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5 and 8.4 times higher than that in low-risk patients. Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer, and the use of 9 points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity.

Application of Caprini risk assessment model for preventing venous thromboembolism / 中国实用护理杂志

Objective To explore the Caprini risk assessment model for the application of the prevention of VTE in clinical nursing. Methods With a cross:sectional survey research, 6 624 patients were interviewed of a hospital from March to June in 2015.The Caprini risk assessment model was used to screen patients with VTE risk assessment. Results Patients have VTE risk in 6 229 cases, accounting for 94.04%. The patients of low risk, moderate risk, high risk, and super high-risk was 1 889 cases, 1 507 cases, 1 930 cases, 903 cases, accounted for 28.52%, 22.75%, 29.14%and 13.64%respectively. Surgical patients with VTE risk, low risk, moderate, high risk and super high-risk rate was 5.15% (79/1 533), 15.72%(241/1 533), 28.77%(441/1 533), 30.59%(469/1 533), 19.77%(303/1 533), the no-surgery group were 6.21% (316/5 091), 32.37% (1 648/5 091), 20.94% (1 066/5 091), 28.68% (1 461/5 091), 11.79%(600/5 091), two groups compare was statistically significant (χ2= 53.46, P = 0.000); High-risk ratio of trauma surgery,thoracic surgery, neurosurgery, orthopedics, mammary gland and thyroid surgery were63.2%、62.9%、61.5%、58.3%、55.8%; High-risk ratio of oncology medical, respiratory medical, neurology medical, cardiology medical were 92.0% , 68.2% , 55.9% and 64.4% . Conclusions Hospitalized patients have high risk of VTE, it is suggested that include VTE in nursing quality evaluation standard, establish an effective system of VTE risk management. Caprini risk assessment model has been clear about the VTE patients should be special attention, and has been great significance to early screening and prevention of VTE.