The short-term outcomes of orthopedic patients classified as high risk for venous thromboembolism using the caprini score: a retrospective study in a secondary hospital

Venous Thromboembolism (VTE) poses a threat to several populations, affecting nearly 10 million people globally. It is the third most common vascular diagnosis, after cardiac ischemic syndromes and stroke. Clinical impacts of VTE include significantly longer lengths of hospital stay, ICU admission and mortality and risk for bleeding. Recommendations suggests the utilization of the Caprini score for orthopedic to identify patients high risk for VTE. Thromboprophylaxis is effective in preventing VTE in at-risk hospitalized medical patients. This study therefore aims to identify the short term outcomes of orthopedic patients high risk for VTE, with and without thrombophylaxis, in terms of mortality, length of hospital stay, ICU admission and bleeding.

This is a retrospective study that included high risk patients based on Caprini score between January 2015 to December 2023. Demographic profile, clinical data and clinical utcomes of the patients were determined. Frequency, Percentage, Mean and Standard deviation were used to describe demographic and clinical data and outcomes while independent samples t-test, Mann Whitney U test, Spearman rho and Chi-square were used for inferential analysis.

A total of 171 high risk patients were included in this study. Mean age of the population was 60 ± 18.0 years, majority were in the 60- 74 age group and most were females 89 (52. 0%). Forty-seven (47) (27.485%) received pharmacologic thromboprophylaxis and 124 (72.514%) did not. No mortality was reported in the thrombophylaxis group while two (1.612%)died in the non prophylaxis group. However, there was no significant association between mortality and lack of prophylaxis. There was a significant difference in terms of hospital stay between the two groups. The thromboprophylaxis group had longer hospital stay (9 ± 5.7 days) compared to the non thrombophylaxis group (7 ± 5.4 days). A total of 6 patients were admitted at the ICU and 5 (10.63%) of those received prophylaxis. This showed a significant association between prophylaxis and ICU admission. Finally, among patients who received thrombophylaxis, 20 (42.55%) experienced major bleeding and zero had non major bleeding. This showed a significant correlation between thrombophylaxis and bleeding events.

The Caprini Risk assessment tool remains valuable in determining those at high risk for VTE, hence, can aid in providing adequate thrombophylaxis for these patients. Even with available guidelines, there remains to be a lack of risk stratification and VTE prophylaxis practice in our institution. There was no significant association between mortality and thrombophylaxis, however, there were significant associations between ICU admission and bleeding. Also, there was a significant difference in the length of hospital stay between groups. Despite the risks for untoward outcomes, still the benefits of thrombophylaxis outweigh the risks.