procedure and instruct them to take their time filling out each ques-
tion. That means sitting down with family members to ask about any
family history of thrombosis, which is the most commonly missed
question and, along with your patient's personal history of thrombo-
sis, is one of the biggest causes of DVT. Don't try to give the assess-
ment the day of surgery. There's a risk that patients will miss a ques-
tion or answer it incorrectly because they haven't had the time to fully
look it over. It's not reasonable to expect patients to know off the top
of their head if their BMI is over 25, if they've had past obstetrical
complications or if they had a venous thromboembolism (VTE) in the
past but thought it not important — perhaps because it was caused by
oral contraceptives that they're no longer taking.
Your patient's answers to those questions will give you an overall
"Caprini score," which you can use on the day of surgery to stratify
each patient's risk of DVT and, subsequently, what measures of pro-
phylaxis you should provide.
Patients with a score of under 5, who are classified as low-risk of
developing DVT, may not need anticoagulant prophylaxis, whereas
you should instruct patients with a score of 5-8, who are deemed at-
risk of developing DVT, to take anticoagulants for 7-10 days following
the surgery, even after they're discharged, or if they are outpatients.
Classify patients who score a 9 or above as very high-risk and tell
them to take a full 30 days of anticoagulant medication.
Precision medicine
Obtaining the score and understanding your patient's risk is only one
part of preventing DVT. The key to cutting down on the rate of throm-
bosis cases is using that score to determine when and how you should
administer thromboprophylaxis to your patient.
Anticoagulants, such as low molecular weight or unfractionated
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