From the Desk of
Joseph A. Caprini, MD, MS, FACS, RVT, DFSVS
My blog is dedicated to everyone around the world who is using the Caprini score to attack the No. 1 preventable cause of death postoperatively—fatal pulmonary emboli.
Since retiring from clinical practice, I am working on important issues regarding venous thromboembolism (VTE) prophylaxis familiar to all of you.
Fatal pulmonary embolism…
…is the number one preventable cause of death postoperatively. Anticoagulant prophylaxis for those “at risk” can prevent most deaths. It’s important to provide prophylaxis for the entire period of patient risk.
A thorough history and physical…
…remains the best tactic to evaluate VTE risk preoperatively. This process is time-consuming currently since physicians have limited time to see each patient and document their findings in the medical record. The cut-and-paste feature of the electronic medical record (EMR) is counterproductive when a poor history and physical is copied during a subsequent patient visit to save the physician’s time.
- Utilizing the EMR to collect correct patient data is important.
- Utilizing patient-friendly forms to facilitate collection of important historical facts including the patient’s family history.
- Adapting voice recognition systems to facilitate patient data collection.
…using, and improving the Caprini score that has been shown to correlate with clinical VTE events. For example:
- Identifying gaps in the effectiveness of the score to predict the likelihood of VTE in specific surgical populations.
- Studying published reports not showing benefit of using the score to determine the reasons behind the lack of success.
- A few areas for improvement include: Inadequate data collection, incorrect score interpretation, improved scoring regarding time and type of surgery, and additional risk factors documented after the score was developed.
…the value and use of the new oral anticoagulants, aspirin, adjusted dose low molecular weight heparin, and combinations of mechanical prophylaxis for VTE prophylaxis.
Create a forum…
…for interested professionals to exchange ideas and provide important contributions to these goals.