Haematology

Caprini VTE Risk Score

VTE risk in surgical patients.

Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.

When to use

Use in surgical and at-risk patients to estimate venous thromboembolism risk and guide thromboprophylaxis.

Why use

It is the most widely used surgical VTE risk-assessment model.

Age

Surgery type

BMI > 25

Swollen legs

Varicose veins

Sepsis (<1 month)

Serious lung disease / pneumonia (<1 month)

Abnormal pulmonary function / COPD

Acute myocardial infarction

Congestive heart failure (<1 month)

History of inflammatory bowel disease

Medical patient at bed rest

Oral contraceptive or HRT

Pregnancy or postpartum (<1 month)

History of unexplained/recurrent miscarriage

Malignancy (present or previous)

Confined to bed > 72 hours

Immobilising plaster cast (<1 month)

Central venous access

History of DVT / PE

Family history of thrombosis

Known thrombophilia (Factor V Leiden, prothrombin 20210A, antiphospholipid, etc.)

Heparin-induced thrombocytopenia

Elevated serum homocysteine

Stroke (<1 month)

Elective major lower-limb arthroplasty

Hip, pelvis or leg fracture (<1 month)

Acute spinal cord injury / paralysis (<1 month)

Background

The Caprini score is a risk-assessment model that estimates the likelihood of venous thromboembolism (VTE) in surgical and other at-risk patients, in order to guide thromboprophylaxis. It aggregates a wide range of weighted factors — including age, type and duration of surgery, body mass index, mobility, malignancy, personal and family history of thrombosis, thrombophilia and several acute medical conditions — with weightings from 1 to 5 points. The total reflects cumulative risk and is mapped to broad risk categories. It is the most widely used surgical VTE risk model.

Interpreting the result

A score of 0 is very low risk and 1–2 is low risk, often manageable with mechanical prophylaxis and early mobilisation; 3–4 is moderate risk; and 5 or more is high risk, where pharmacological prophylaxis is usually indicated unless bleeding risk is prohibitive. The exact thresholds at which pharmacological prophylaxis is recommended vary between guidelines and surgical specialties, and the decision always balances thrombosis risk against bleeding risk and local policy.

Advice

Higher scores indicate higher VTE risk and a stronger indication for pharmacological prophylaxis — weigh against bleeding risk and follow local policy. Thresholds for prophylaxis vary by guideline.

Worked example

A 63-year-old (61–74: 2) undergoing major surgery lasting over 45 minutes (2) with a previous DVT (3) scores 7. This is high risk, supporting pharmacological prophylaxis alongside mechanical measures, provided bleeding risk is acceptable.

Pearls / pitfalls

Several versions exist with slightly different items and point weightings — use one version consistently and know which your institution has adopted.
The score guides, but does not dictate, prophylaxis: always weigh against bleeding risk and follow local or guideline thresholds.
Easily missed high-weight items (prior VTE, thrombophilia, family history) substantially change the category, so take a careful history.
It estimates VTE risk only; bleeding risk must be assessed separately before starting pharmacological prophylaxis.

Evidence & validation

Developed by Joseph Caprini and refined over successive iterations, the score has been validated in numerous surgical populations where higher scores correlate with higher observed VTE rates. Versions of it are referenced in surgical thromboprophylaxis guidance, including from the American College of Chest Physicians.

Frequently asked questions

What Caprini score needs pharmacological prophylaxis?

Generally a score of 5 or more is considered high risk and supports pharmacological prophylaxis if bleeding risk allows. Exact thresholds vary by guideline and surgical specialty, so follow local policy.

Are there different versions of the Caprini score?

Yes. The model has been revised over time, with versions differing slightly in their items and weightings. It is important to use one version consistently and to know which one your institution follows.

Does a high score mean prophylaxis must be given?

No. A high score indicates greater VTE risk and a stronger indication for prophylaxis, but the decision balances this against bleeding risk and patient factors. Mechanical prophylaxis is an option when anticoagulation is contraindicated.

Does the Caprini score assess bleeding risk?

No. It estimates only the risk of venous thromboembolism. Bleeding risk is assessed separately, and both are weighed together when deciding on pharmacological prophylaxis.

References

Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2–3):70–78.
Gould MK, et al. Prevention of VTE in nonorthopedic surgical patients: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2012.

About the creator

Joseph Caprini

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