Your Risk Assessment Results

Your Responses

Planned surgery [check only one]: Major (longer than 45 minutes), including laparoscopic and arthroscopic surgery
Past major surgery (more than 45 minutes) within the last month: No
Visible varicose veins: No
A history of Inflammatory Bowel Disease (IBD) (for example, Crohn's disease or ulcerative colitis): Yes
Swollen legs (current): No
Overweight or obese (Body Mass Index of 25 or higher): Yes
Heart attack within the past month: No
Congestive heart failure within the past month: No
Serious infection (for example, pneumonia) within the past month.: No
Existing lung disease including emphysema or COPD : No
Suffered a stroke within the past month : No
Bed rest or restricted mobility during the past month: None
Non-removable plaster cast, removable leg brace or mold that has kept you from moving your leg within the last month: No
Age - Please check one box.: 40 or younger
Please indicate your gender.: Female
Current use of birth control or Hormone Replacement Therapy (HRT): No
Pregnant or had a baby within the last month: No
History of unexplained stillborn infant, recurrent spontaneous abortion (more than 3), premature birth with toxemia or growth restricted infant.: No
Page 1 Total: 4
Current or past malignancy, excluding basal cell skin cancer: No
Tube in blood vessel or neck or chest that delivers blood or medicine directly to heart within the past month (also called central venous access, PICC line, or port): Yes
Past personal history or current Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): No
Family history of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): No
Personal or family history of positive blood test indicating an increased risk of blood clotting: No
Fracture of the hip, pelvis, or leg: No
Multiple traumatic injuries (for example multiple broken bones due to a fall or car accident): No
Spinal cord injury resulting in paralysis: No
Page 2 Total: 2
Your Caprini DVT Risk Assessment Score:: 6
Patient code:

Your Caprini DVT Risk Score:    6

Suggested Prophylaxis Protocols

Based on multiple publications (see new articles)

Risk Score Prophylaxis Duration VTE Rate*
0 [lowest] Early ambulation During hospitalization < 0.5%
1-2 [low] Either compression boots
Or prophylactic anticoagulation
During hospitalization 1.5%
3-4 [moderate] Compression boots
AND prophylactic anticoagulation
During hospitalization 3.0%
5-8 [high] Compression boots
AND prophylactic anticoagulation
7-10 days total 6.0%
>8 [highest] Compression boots
AND prophylactic anticoagulation
30 days total 6-18%

  • 30- and 60-day clinical VTE rate based on patient groups and type of surgery without prophylaxis
  • Compression boots should be worn during hospitalization and portable boots may be beneficial post-discharge especially when leg swelling is present or the score is very high.
Print Friendly

This button clears all data and returns you to the start of the form.