Caprini Score for VTE Risk in Surgical Patients
Validated VTE risk stratification tool for surgical patients. Each risk factor is weighted 1-5 points. Total score guides prophylaxis: very low risk (0) = early mobilisation only; low (1-2) = mechanical prophylaxis; moderate (3-4) = LMWH or mechanical; high (5 or above) = LMWH for extended duration. Originally validated by Caprini et al. 2005 in general and abdominal/pelvic surgery. Widely used in perioperative medicine.
Score interpretation
Caprini 0 -- very low risk; VTE incidence below 0.5%
→ Early ambulation only; no pharmacological or mechanical prophylaxis required; patient education on importance of early mobilisation; hydration; document risk assessment in notes.
Caprini 1-2 -- low risk; VTE incidence approximately 1.5%
→ Mechanical prophylaxis: TED stockings plus intermittent pneumatic compression (IPC) perioperatively and until mobile; pharmacological prophylaxis not required unless additional bleeding risk considerations; early mobilisation; maintain hydration; reassess daily.
Caprini 3-4 -- moderate risk; VTE incidence approximately 3%
→ LMWH (enoxaparin 20-40 mg OD SC, or dalteparin 2500-5000 units OD SC depending on weight and renal function) plus mechanical prophylaxis (TED + IPC); start LMWH 12 hours post-operatively (6-12 hours if low bleeding risk); continue for 7-10 days; assess bleeding risk before prescribing; if bleeding risk high: mechanical prophylaxis only until haemostasis secured; document VTE risk and prophylaxis decision.
Caprini 5 or above -- high VTE risk; VTE incidence above 6%; extended prophylaxis often required
→ LMWH plus mechanical prophylaxis (TED + IPC) perioperatively; for cancer surgery: extended prophylaxis with LMWH for 28 days post-operatively (NICE NG89 -- significantly reduces VTE in abdominal/pelvic cancer surgery); for orthopaedic surgery: hip/knee replacement -- LMWH for 35 days (hip) or 14 days (knee); if prior VTE or confirmed thrombophilia: consider extending prophylaxis to 6 weeks; regularly review bleeding risk vs VTE benefit; senior surgical and haematology input if complex; document in operation notes and discharge summary.
Interpretation bands for the Caprini VTE Score. Apply clinical judgement and local guidance.
References
- Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2-3):70-78.
- NICE NG89. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired DVT or PE. NICE. 2018 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- HERDOO2 Rule for Discontinuing Anticoagulation in Unprovoked VTE · Venous Thromboembolism
- RIETE Score for Bleeding Risk in VTE · Venous Thromboembolism
- Wells Criteria for PE · Venous Thromboembolism
- Wells Criteria for DVT · Venous Thromboembolism
- PERC Rule for PE · Venous Thromboembolism
- Revised Geneva Score for PE · Venous Thromboembolism
- Rivaroxaban (PE Treatment) · Venous Thromboembolism
- Enoxaparin (VTE Prophylaxis — Post-Surgery) · Low Molecular Weight Heparin (LMWH) — VTE Prophylaxis
- Rivaroxaban (Perioperative VTE Prophylaxis) · Direct Oral Anticoagulant — VTE Prophylaxis Post-Surgery
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Enoxaparin (LMWH) · Anticoagulant
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.