Age 0 to 40 years (0)
41 to 60 years (1)
61 to 74 years (2)
75 years or older (3)
Each of the following criteria that apply now or within the past month, receives 1 point:
Minor surgery (less than 45 minutes, including anesthesia time) is planned
Past major surgery (more than 45 minutes) within the last month
Visible varicose veins
History of active or inactive inflammatory bowel disease (IBD; eg, Crohn disease or ulcerative colitis)
Swollen legs (current), including pitting edema of any level, loss of definition of the bony prominences, obscured foot veins, or indentation of the leg when a stocking is removed
Overweight or obese (body mass index [BMI] above 25 kg/m 2)
Heart failure (HF); includes patients who had an episode within the last month or patients who are currently being treated with medication for HF even if there was no acute episode in the last month
Serious infection, eg, pneumonia (a patient who requires hospitalization and intravenous antibiotics for treatment)
Enter number of lung diseases. Lung diseases eg, emphysema or COPD (also includes any interstitial lung disease and patients with abnormal pulmonary function tests. This would include, but is not limited to, any patient with sarcoidosis, pulmonary fibrosis, pulmonary hypertension, and bronchiectasis. (Patients who present with more than 1 diagnosis meeting the criteria for lung disease receive 1 point for each diagnosis).
On bed rest or restricted mobility, Δ including a removable leg brace, for less than 72 hours
Each of these other risk factors that apply now or within the past month ¶ receives 1 point:
BMI above 40 kg/m 2
Smoking within the last month (smoking is defined as the inhalation of anything that burns [eg, tobacco, marijuana], or vaping)
Diabetes requiring insulin (does not include other oral or parenteral medications used for the treatment of diabetes)
Chemotherapy (includes chemotherapy treatments used for any medical condition (eg, methotrexate for rheumatoid arthritis, hydroxyurea for essential thrombocytosis)
Blood transfusion(s) (1 point for 1 or more transfusion)
Length of surgery over 2 hours (including anesthesia time). NOTE: this point is not counted if hip or knee replacement surgery is indicated below.
For females only: Each of the following criteria receives 1 point:
Current use of birth control or hormone replacement therapy (includes estrogen contraceptives of any type, estrogen-like drugs [eg, tamoxifen, anastrozole, letrozole]; does not include testosterone replacement therapy)
Pregnant or had a baby within the last month
History of unexplained stillborn infant, recurrent spontaneous abortion (3 or more), premature birth with toxemia or growth restricted infant
Each of the following criteria receives 2 points:
Enter number of current or past malignancies (excluding skin cancer but including melanoma; every incidence of cancer is considered separately and points are additive) (Patients who present with more than 1 diagnosis meeting the criteria for current or past malignancies receive 2 points for each diagnosis).
Planned major surgery (including laparoscopic and arthroscopic) lasting longer than 45 minutes (including anesthesia time). NOTE: these points are not counted if hip or knee replacement surgery is indicated below.
Nonremovable cast or mold that prevents leg movement within last month (includes any limitation of mobility which would interfere with calf muscle pumping action such as a leg brace or cast; also includes patients using crutches who are nonweightbearing on one leg. Does not include use of an assistive device for stability)
Tube in blood vessel in neck or chest that delivers blood or medicine directly to the heart within the last month (eg, central venous access, PICC line, port)
Confined to bed Δ for 72 hours or more (unable to ambulate continuously 30 feet; does not include use of an assistive device for stability)
Each of the following criteria receives 3 points:
Enter number of episodes of blood clots (includes: deep vein thrombosis (DVT), pulmonary embolism (PE); or superficial vein thrombosis (SVT); does not include arterial clots unless the result of paradoxical embolism). Each episode is a separate event for scoring. (Patients who present with more than 1 episode meeting the criteria for current or past history of blood clots receive 3 points for each diagnosis).
Family history of blood clots (includes first-, second-, and third-degree relatives.)
Enter number of personal or family history of positive blood test indicating an increased risk of blood clotting (eg, genetic or acquired thrombophilia). (Patients who present with more than 1 diagnosis meeting criteria for positive blood testing receive 3 points for each positive blood test). Genetic (inherited) factors: Factor V Leiden/activated protein C resistance, antithrombin III deficiency, protein C and protein S deficiency, dysfibrinogenemia, 20210A prothrombin mutation. Acquired factors: lupus anticoagulant, antiphospholipid antibodies, myeloproliferative disorders [including thrombocytosis], disorders of plasminogen and plasmin activation, heparin-induced thrombocytopenia, hyperviscosity syndromes, and homocysteinemia. HIV infection is an acquired thrombophilia.
Each of the following criteria that apply now or within the past month receives 5 points:
Enter the number of elective hip or knee joint replacements (total or partial; points assessed for each surgical procedure [eg, bilateral arthroplasty = 10 points]). (Patients who present with more than 1 surgery meeting the criteria for elective hip or knee joint replacement receive 5 points for each surgery).
Broken hip, pelvis, or leg (fractures requiring surgical repair receive 5 points for the fracture and additional points for the surgery depending on time [eg, >45 minutes] and type [eg, hip replacement], as well as points for any resulting restricted mobility (eg, cast placed)
Serious trauma (eg, multiple broken bones due to a fall or car accident)
Spinal cord injury resulting in paralysis