I evaluate all my patients for blood clot risk before surgery using the Caprini risk score. I use compression on your legs during the surgery to keep your blood flow moving. I focus on pain control and encourage you to get out of bed and move after surgery. If you need to go on a long car trip or plane ride after surgery for the first 3-4 weeks, I tell you to get up and move around every hour or two.
Even with all of this, you are still at risk.
So how do you know if you have a pulmonary embolism?
Come in, the Wells test. This is not to predict your risk of a blood clot like the Caprini score. This is to try to figure out if you have a pulmonary embolism. A score of 4 or higher on the Wells test indicates a PE is likely. Why am I writing about this? Because pulmonary embolism is totally tricky. The symptoms are super vague: short of breath, pain with deep breathing, elevated heart rate. I have had few episodes of this, but one patient presented 10 days out with a complaint of “shoulder pain.” Your oxygen saturation level may be normal. You may not have a sign of a blood clot in your leg. The timing can be a week out or a month out from your surgery.
Wells test:
- Clinical signs and symptoms of DVT blood clot in your leg SCORE 3
- PE is #1 diagnosis OR equally likely SCORE 3
- Heart rate > 100 SCORE 1.5
- Immobilization at least 3 days OR surgery in the previous 4 weeks SCORE 1.5
- Previous, objectively diagnosed PE or DVT SCORE 1.5
- Hemoptysis (coughing up blood) SCORE 1
- Malignancy w/ treatment within 6 months or palliative SCORE 1