Monash Medical Centre, Vascular Surgery Department, Clayton, Australia.
Serdang Hospital, Universiti Putra Malaysia, Department of Surgery, UPM Serdang, Malaysia.
Med J Malaysia. 2024 May;79(3):320-325.
Caprini risk assessment model (RAM) has been validated in Caucasians but evidence of its suitability in Asian surgical patients is still unknown. This study aims to determine the efficacy of Caprini model in venous thromboembolism (VTE) risk assessment among Asian surgical patients.
Consecutive surgical patients with Asian ethnicities admitted to a tertiary public hospital between January 2013 and December 2014, were included. Their demographic details, VTE risk factors and scores based on Caprini RAM were recorded. Primary outcome of this study was symptomatic VTE within 90 days of hospitalisation. Fisher's exact test and Lasso regression were performed for statistical analysis.
A total of 4206 patients were included in this study. Distribution of this study population by risk level was very low, 14.7%; low, 44.1%; moderate, 25.6% and high, 15.7%. The overall symptomatic VTE incidence within 90 days was 0.5%. The incidence of deep venous thrombosis (DVT), pulmonary embolism (PE) and both was 0.31%, 0.19% and 0.05% respectively. VTE incidence by risk category was very low, 0%; low, 0.16%; moderate, 0.37% and high, 2.12%. Obesity (BMI >25), history of prior major surgery, history of DVT/PE and high-risk category (scores ≥5) were significant VTE factors with odds ratio > 5.0. Following the Caprini RAM with ACCP preventive recommendations, an estimated 85% of surgical patients would need prophylaxis.
The overall VTE incidence among Asian surgical patients is low. Prophylaxis using Caprini RAM may subject a low incidence patient population to over utilisation of thromboprophylaxis and therefore not cost-effective when applied to Asian patients.
卡普里尼风险评估模型（RAM）已在白种人群中得到验证，但在亚洲手术患者中的适用性证据尚不清楚。本研究旨在确定卡普里尼模型在亚洲手术患者静脉血栓栓塞（VTE）风险评估中的有效性。
连续纳入 2013 年 1 月至 2014 年 12 月期间在一家三级公立医院住院的亚洲裔手术患者。记录其人口统计学资料、VTE 危险因素和基于卡普里尼 RAM 的评分。本研究的主要结局为住院后 90 天内出现症状性 VTE。采用 Fisher 确切检验和套索回归进行统计学分析。
本研究共纳入 4206 例患者。按风险水平分布，极低危 14.7%、低危 44.1%、中危 25.6%和高危 15.7%。90 天内出现症状性 VTE 的总发生率为 0.5%。深静脉血栓形成（DVT）、肺栓塞（PE）和两者均有的发生率分别为 0.31%、0.19%和 0.05%。按风险类别，VTE 发生率极低，0%；低危，0.16%；中危，0.37%；高危，2.12%。肥胖（BMI>25）、既往大手术史、DVT/PE 史和高危类别（评分≥5）是 VTE 的显著危险因素，其比值比>5.0。按照卡普里尼 RAM 结合 ACCP 预防建议，估计 85%的手术患者需要预防。
亚洲手术患者的总体 VTE 发生率较低。使用卡普里尼 RAM 进行预防可能会使低发生率的患者群体过度使用血栓预防药物，因此在亚洲患者中应用时可能并不经济。
