Pak Kai, Wong
(2014)
A prospective observational study on
post-operative major surgical patients
developing silent deep vein thrombosis
at Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction: Silent deep vein thrombosis (DVT) is one of the life-threatening
complications affecting surgical patients. So far there is only one study documenting the
incidence of silent DVT in Malaysia. Besides, no efforts have been made to evaluate the
use of Caprini risk assessment model to identify subjects who are in need of prompt DVT
prophylaxis.
Objectives: The aims of this study are to determine the incidence of silent DVT and
evaluate the potential utility of Caprini risk assessment model to target high risk subjects
for DVT prophylaxis.
Methods: This is a prospective cohort study involving 55 HUSM surgical subjects who are
at risk of silent DVT. Each subject had a preoperative and postoperative compression
ultrasound complemented by duplex venous ultrasonography of deep venous system
performed by two separate radiologists. Caprini risk assessment scores were calculated for
each study participants and the decision on the administration of DVT prophylaxis was
made based on the clinical judgement of the clinicians in charge without knowing the
calculated Caprini risk scores. The association between DVT prophylaxis and Caprini risk
scores were analysed using simple logistic regression. Any p value that is less than 0.05 is
considered statistically significant.
Results: Not a single subject developed DVT (incidence rate of silent DVT = 0%, n=0).
There is a significant association between DVT prophylaxis and Caprini risk scores (OR
8.16 (95% CI: 1.01, 68.74), p value = 0.008). Besides, the use of central venous catheter is
also significantly associated with the use of DVT prophylaxis (OR 6.34 (95% CI: 1.62,
24.80), p value = 0.016). Interestingly the use of central venous catheter resulted in more
than 4 point increment of Caprini risk scores (mean increment: 4.186 (95% CI: 3.164,
5.207), p value <0.001) instead of the usual 2 points allotted to this risk factor.
Conclusion: Silent DVT is virtually non-existent in this study setting. The judicious use of
DVT prophylaxis, which is guided by the inadvertent use of Caprini risk score during dayto-
day practice, may explain the effective prevention of silent DVT at this setting.
Nevertheless, further studies are warranted to further characterize the utility of Caprini risk
assessment scores for the prediction of silent DVT in this setting.
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