• Ann. Thorac. Surg. · Mar 2018

    Caprini Risk Model Decreases Venous Thromboembolism Rates in Thoracic Surgery Cancer Patients.

    • Helene M Sterbling, Amy K Rosen, Krista J Hachey, Niru S Vellanki, Philip D Hewes, Sowmya R Rao, Emma Pinjic, Hiran C Fernando, and Virginia R Litle.
    • School of Medicine, Boston University School of Medicine, Boston, Massachusetts.
    • Ann. Thorac. Surg. 2018 Mar 1; 105 (3): 879-885.

    BackgroundExtended postoperative chemoprophylaxis is effective in reducing venous thromboembolism (VTE) among general surgical patients. We hypothesized that implementation of the Caprini risk assessment model (RAM) would reduce VTE rates among patients undergoing lung and esophageal cancer surgery.MethodsThe Caprini RAM, consisting of patient risk stratification and extended postoperative chemoprophylaxis with low molecular weight heparin, was implemented on the thoracic surgery service at Boston Medical Center in July 2014. Patients undergoing lung and esophageal cancer resections were enrolled in the postintervention group beginning in July 2014. Provider and patient adherence to treatment protocol was audited. Venous thromboembolism and adverse bleeding events were monitored for 60 days postoperatively. A preintervention control group including esophagectomy and lung cancer resection patients (January 2005 to June 2013) was used for VTE rate comparison. Exclusion criteria included chronic anticoagulation and presence of filters.ResultsThere were 302 lung and esophageal cancer resection patients in the preintervention cohort, and 64 thoracic cancer resections in the postintervention group. The overall VTE rates for preintervention and postintervention cohorts were 7.3% (22 of 302) and 3.1% (2 of 64), respectively (p = 0.28). Provider adherence to Caprini RAM score assignment was 100%, whereas patient adherence to treatment was 97.4%. There were no adverse bleeding events.ConclusionsThis study demonstrates a trend toward decreased symptomatic VTE after Caprini RAM implementation, as demonstrated among high-risk cancer patients. The absence of bleeding complications and high provider and patient adherence to VTE RAM support the safety and feasibility of a VTE prevention protocol in thoracic surgery patients.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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