Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients
Introduction Preoperative patients with knee osteoarthritis have a significantly increased risk of venous thromboembolism (VTE). While the Caprini risk assessment model offers some clinical guidance in predicting deep vein thrombosis (DVT), it has a relatively low predictive accuracy. Enhancing the...
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SAGE Publishing
2025-01-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296241311265 |
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| author | Yi-Feng Guo MS Dingding Zhang PhD Yaping Chen MS Weinan Liu BS Na Gao MS Xisheng Weng MD Jin Lin MD Jin Jin MD Wenwei Qian MD Xu Yang BS Yin-Ping Zhang PhD Xiaopeng Huo BS |
| author_facet | Yi-Feng Guo MS Dingding Zhang PhD Yaping Chen MS Weinan Liu BS Na Gao MS Xisheng Weng MD Jin Lin MD Jin Jin MD Wenwei Qian MD Xu Yang BS Yin-Ping Zhang PhD Xiaopeng Huo BS |
| author_sort | Yi-Feng Guo MS |
| collection | DOAJ |
| description | Introduction Preoperative patients with knee osteoarthritis have a significantly increased risk of venous thromboembolism (VTE). While the Caprini risk assessment model offers some clinical guidance in predicting deep vein thrombosis (DVT), it has a relatively low predictive accuracy. Enhancing the model by integrating biomarkers, such as D-dimers, can potentially improve its accuracy. In this study, we explored the effectiveness of combining the Caprini risk model with D-dimer levels for individualized DVT risk assessment in patients with knee osteoarthritis. Materials and Methods This retrospective cohort study included 1605 knee osteoarthritis patients scheduled for total knee arthroplasty from Peking Union Medical College Hospital, screened between January 2015 and December 2018. A revised Caprini risk stratification model was developed, and a predictive DVT model was developed based on this revised system. The sensitivity, specificity, and the area under the curve (AUC) were used to determine predictive effectiveness of the model. Results In the revised Caprini risk stratification, the incidence of DVT increased with higher risk levels: 2.52% in the low-risk group (scores 0-2), 2.88% in the moderate-risk group (score 3), 6.47% in the high-risk group (score 4), and 9.09% in the highest-risk group (score ≥ 5). The incidence of DVT was 3.869-fold higher in the highest-risk group and 2.676-fold higher in the high-risk group compared to the low-risk group (p = 0.013 and p = 0.014, respectively). Combining the revised Caprini risk stratification with D-dimer level demonstrated an improved AUC of 0.792, compared to D-dimer level alone (AUC 0.774) and the revised Caprini model alone (AUC 0.598). Furthermore, applying specific D-dimer thresholds across the four Caprini risk stratifications outperformed the combination of the revised Caprini model and D-dimer level in terms of AUC, specificity, and reduction in unnecessary ultrasonography. Using the Youden index, the AUC for the threshold-based method was slightly higher (0.775 vs 0.754, p = 0.310), with significantly better specificity (76.8% vs 63.6%, p < 0.001) and a greater reduction in ultrasound use (74.1% vs 61.4%). At a sensitivity of 85.5%, the differences were modest but still favored the threshold-based approach. At a sensitivity of 100%, the specificity (36.0% vs 24.7%, p < 0.001) and ultrasound reduction (34.8% vs 23.9%) were significantly better. Conclusion The revised Caprini risk stratification improves preoperative DVT prediction in patients with knee osteoarthritis. Incorporating specific D-dimer thresholds into the four-level Caprini risk model enhances specificity and reduces unnecessary ultrasonography, outperforming both the use of individual indicators and the combination of the revised Caprini model with D-dimer level. |
| format | Article |
| id | doaj-art-86dd1adb58984d16adb3f1f469201a26 |
| institution | Kabale University |
| issn | 1938-2723 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SAGE Publishing |
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| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj-art-86dd1adb58984d16adb3f1f469201a262025-01-09T15:03:20ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232025-01-013110.1177/10760296241311265Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis PatientsYi-Feng Guo MS0Dingding Zhang PhD1Yaping Chen MS2Weinan Liu BS3Na Gao MS4Xisheng Weng MD5Jin Lin MD6Jin Jin MD7Wenwei Qian MD8Xu Yang BS9Yin-Ping Zhang PhD10Xiaopeng Huo BS11 School of Nursing, , Xi'an, Shaanxi, China Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China School of Nursing, , Xi'an, Shaanxi, China Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, ChinaIntroduction Preoperative patients with knee osteoarthritis have a significantly increased risk of venous thromboembolism (VTE). While the Caprini risk assessment model offers some clinical guidance in predicting deep vein thrombosis (DVT), it has a relatively low predictive accuracy. Enhancing the model by integrating biomarkers, such as D-dimers, can potentially improve its accuracy. In this study, we explored the effectiveness of combining the Caprini risk model with D-dimer levels for individualized DVT risk assessment in patients with knee osteoarthritis. Materials and Methods This retrospective cohort study included 1605 knee osteoarthritis patients scheduled for total knee arthroplasty from Peking Union Medical College Hospital, screened between January 2015 and December 2018. A revised Caprini risk stratification model was developed, and a predictive DVT model was developed based on this revised system. The sensitivity, specificity, and the area under the curve (AUC) were used to determine predictive effectiveness of the model. Results In the revised Caprini risk stratification, the incidence of DVT increased with higher risk levels: 2.52% in the low-risk group (scores 0-2), 2.88% in the moderate-risk group (score 3), 6.47% in the high-risk group (score 4), and 9.09% in the highest-risk group (score ≥ 5). The incidence of DVT was 3.869-fold higher in the highest-risk group and 2.676-fold higher in the high-risk group compared to the low-risk group (p = 0.013 and p = 0.014, respectively). Combining the revised Caprini risk stratification with D-dimer level demonstrated an improved AUC of 0.792, compared to D-dimer level alone (AUC 0.774) and the revised Caprini model alone (AUC 0.598). Furthermore, applying specific D-dimer thresholds across the four Caprini risk stratifications outperformed the combination of the revised Caprini model and D-dimer level in terms of AUC, specificity, and reduction in unnecessary ultrasonography. Using the Youden index, the AUC for the threshold-based method was slightly higher (0.775 vs 0.754, p = 0.310), with significantly better specificity (76.8% vs 63.6%, p < 0.001) and a greater reduction in ultrasound use (74.1% vs 61.4%). At a sensitivity of 85.5%, the differences were modest but still favored the threshold-based approach. At a sensitivity of 100%, the specificity (36.0% vs 24.7%, p < 0.001) and ultrasound reduction (34.8% vs 23.9%) were significantly better. Conclusion The revised Caprini risk stratification improves preoperative DVT prediction in patients with knee osteoarthritis. Incorporating specific D-dimer thresholds into the four-level Caprini risk model enhances specificity and reduces unnecessary ultrasonography, outperforming both the use of individual indicators and the combination of the revised Caprini model with D-dimer level.https://doi.org/10.1177/10760296241311265 |
| spellingShingle | Yi-Feng Guo MS Dingding Zhang PhD Yaping Chen MS Weinan Liu BS Na Gao MS Xisheng Weng MD Jin Lin MD Jin Jin MD Wenwei Qian MD Xu Yang BS Yin-Ping Zhang PhD Xiaopeng Huo BS Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients Clinical and Applied Thrombosis/Hemostasis |
| title | Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients |
| title_full | Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients |
| title_fullStr | Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients |
| title_full_unstemmed | Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients |
| title_short | Integrating D-Dimer Thresholds into the Revised Caprini Risk Stratification to Predict Deep Vein Thrombosis Risk in Preoperative Knee Osteoarthritis Patients |
| title_sort | integrating d dimer thresholds into the revised caprini risk stratification to predict deep vein thrombosis risk in preoperative knee osteoarthritis patients |
| url | https://doi.org/10.1177/10760296241311265 |
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