Risk Assessment Total Risk1 Point Risk Factors Age 40-59 Prior Major Surgery (less than one month) Varicose Veins Swollen Legs (current) Obesity (BMI>30) Abnormal pulmonary function (COPD) Medical patient currently on bed rest Leg plaster cast or brace Oral contraceptives or hormone replacement therapy Pregnancy or postpartum (<1 month) Use of tourniquet Severe Peripheral Arterial Disease High Risk of Bleeding Current Smoker History of Hypercoagulability 2 Point Risk Factors Age 60-74 Prior Major Surgery (>60min) Arthroscopic Surgery (>60 min) Laparoscopic Surgery (<60 min) Previous Malignancy Morbid Obesity (BMI>40) General Anesthesia (>30min) 3 Point Risk Factors Aage 75+ Prior Major Surgery (2-3 hours) BMI > 50 (Veinous stasis syndrome) History of SVT, DVT/PE Family History of DVT/PE Present Cancer or Chemotherapy 5 Point Risk Factors Elective Major Lower Extremity Arthroplasty Hip, Pelvis, or Leg Fracture (<1 month) Multiple Trauma (<1 month) Major Surgery Lasting Over 3 Hours If other above, describe here.Name* First Last Phone*Email*
