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Caprini model may help predict VTE risk after lung cancer resection
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A risk assessment model already used in medicine to predict the likelihood of venous thromboembolism could improve risk stratification among patients with lung cancer after resection, according to researchers at Boston University.
“The Caprini risk assessment model is used as a VTE risk assessment tool in other surgical specialties, including general, vascular and plastic surgery, as well as gynecologic oncology,” Virginia R. Litle, MD, associate professor of surgery at Boston University School of Medicine, said in a press release.
Virginia R. Litle
“In abdominal and pelvic cancer patients, the [risk assessment model] helps physicians evaluate extended prophylactic use of blood thinners, but it has not been applied in thoracic surgery,” she said.
Using data from the charts of 232 patients who underwent lung resection between 2005 and 2013, Litle and colleagues categorized patients by VTE risk according to the Caprini model.
The model comprises 42 risk factors, including open surgery, history of VTE, central venous access, BMI greater than 30 kg/m2 and malignancy. The Caprini score categories are low-to-moderate (less than four risk factors), high (5-8 risk factors) and highest (more than nine risk factors).
By 60 days, 12 patients developed VTE, of whom six experienced pulmonary embolism. The mean Caprini score for patients who developed VTE was higher compared with those who did not develop VTE (11.83 ± 3.74 vs. 8.07 ± 2.84; P < .001).
VTE incidence was 0% in the low-to-moderate score group, 1.67% in the high score group and 10.42% in the highest score group. The single death that occurred was a patient with a pulmonary embolism in the highest Caprini group.
When nine was used as the cutoff for highest VTE risk, the model demonstrated 80% sensitivity, 60.9% specificity and 61.2% accuracy.
More than 90% of VTEs occurred in patients who underwent open thoracotomy. With VTE risk unaffected by minimally invasive video-assisted thoracoscopic surgery, the researchers recommended it not be added at this time to the Caprini model until further investigations in a larger patient set.
“This risk assessment scoring system can be used to determine which lung resection patients may potentially benefit from preventive blood thinner therapy after discharge,” Litle said. “We have measured these scores and found that a prolonged course of enoxaparin sodium (Lovenox, Sanofi-Aventis) or other blood thinners may improve the risk of dying of this complication after a lung cancer operation.”
Reference: Hachey KJ, et al. Abstract P34. Presented at: The American Association for Thoracic Surgery Annual Meeting; April 25-29; Seattle.
Disclosure: Litle reports no relevant financial disclosures.