The Caprini risk assessment model is used perioperatively. A 65-year-old man with BMI 35 kg/m², prior DVT, and undergoing a 3-hour major abdominal operation for colorectal cancer is assessed. Which VTE prophylaxis strategy is MOST appropriate?
- A Early ambulation alone is sufficient
- B LMWH plus mechanical compression, continued for 28 days post-discharge (extended prophylaxis) ✓
- C Mechanical compression stockings alone
- D Low molecular weight heparin (LMWH) alone
Explanation
This patient has a high Caprini score (age 61-74 = 2, BMI >25 = 1, prior DVT = 3, major surgery >45 min = 2, cancer = 2; total ≥9 = highest risk). For high-risk patients undergoing major cancer surgery, current ASCO and NICE guidelines recommend combined pharmacological (LMWH) and mechanical prophylaxis, with extended post-discharge LMWH for 28 days, as colorectal cancer surgery patients have substantially elevated VTE risk persisting beyond hospitalisation. This is supported by the ENOXACAN II trial which demonstrated 28-day LMWH reduced VTE without increasing bleeding in abdominal cancer surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.