extent of the scheduled surgery, but also the patient's medical
comorbidities, personal and family history of clots, and other recog-
nized factors that help you identify clotting risk. The Caprini score
guides you to ask the questions that can reveal a patient's true risk
of VTE. The exhaustive list of questions lets providers create an
aggregate risk factor score, which will help determine the preventa-
tive measures that would work best on a case-by-case basis.
High Caprini scores should prompt you to further assess
patients to see how to modify and reduce their risk factors.
Once you've identified risk factors, you need to stop, slow down
and ask yourself if any of them are modifiable. For example:
• Has a patient had a recent operation? Maybe you can wait
longer than 30 days to perform an elective procedure to ensure
risk from a prior anesthetic has resolved.
• Does a cancer patient have a port inserted for the infusion of
chemotherapy? Try to remove the port in advance of surgery to
eliminate it as a potential thrombotic source.
• Are young female patients on oral contraceptives, which are
known to be associated with clots? Have them stop taking the
pills 4 weeks before surgery, so the medications are metabolized
long before they enter your ORs.
Clearly, consideration of VTE risk level at a pre-op visit, as
opposed to in the pre-op holding area, may allow modification of
identified risk factors.
Preventative measures
For patients who are still at risk when they present for surgery,
consider implementing some or all of the following proven VTE
prevention measures:
• Anesthesia adjustment. Some modalities are more favorable to
9 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 7
