by Rashi Modey, Mrunalini Ghangrekar, Divya Honavar, Raina Singhal, The GTF Group
Introduction: We are High School students and members of Global Thrombosis Forum (GTF, www.gtfonline.net), an affiliate of the North American Thrombosis Forum. Our mission is to spread awareness of thrombosis in the community. We conduct research, present, and publish our work to share our knowledge of thrombosis.
We took on the project of interviewing a World-Famous physician, Joseph Caprini, MD, who has contributed significantly to Medicine by inventing his Caprini Score that has been used all over the World and has saved millions of lives. By interviewing Dr. Caprini and his achievements, we wanted to learn from his success and how he invented this major tool to help the physician community and patients all over the World.
Joseph Caprini, MD:
Dr. Joseph Caprini
Dr. Caprini is a Senior Clinician Educator at the Pritzker School of Medicine at the University of Chicago, and an Emeritus physician at NorthShore University Health System in Evanston, Illinois with over 56 years of experience in the medical field. He graduated from Hahnemann University Medical School in Philadelphia in 1965. In addition to being a member of the medical facilities such as Evanston Hospital and Glenbrook Hospital, he is a part of many medical societies including the European Venous Forum where he is a founding member, and the American Venous Forum, where he served as President from 2009-2010. Dr. Caprini has authored and co-authored over 449 articles in international peer-reviewed journals, and abstracts, etc. He has delivered over 1,744 lectures worldwide on a variety of topics. He was also a part of the creation of several videos and movies such as “Repair of Giant Epigastric Hernia”. Dr. Caprini is the author of the Deep Vein Thrombosis (DVT) Risk Assessment which is in use in many countries around the world in nearly 5 million patients. Dr. Caprini now works with many GTF students on various levels conducting research, writing research publications, and creating informational videos.
Purpose of the interview:
The purpose of this interview was to learn from Dr. Caprini’s knowledge and experience from the several boards, committees, and associations he is a part of, as well as the publications and lectures he has given. The advice and life lessons Dr. Caprini offered us during the interview have been very impactful and we can surely apply it to our own lives. The tremendous amount of time and effort he puts into his work is truly inspiring and it was such an honour to interview him.
Qs and As:
Mrunalini: What motivated you to pursue the MD?
Dr. Caprini: My motivation comes in 3 parts. My oldest sister at the age of 1 1/2 hurt her head and was severely disabled, and my grandma took care of her as a child till she turned 70. My father’s other sister went to medical school and was the second woman to graduate from the University of Pittsburgh in 1927. She had a tough social life. There was a family history of studying medicine anatomy lab, earning enough money to get through school. Secondly, I had a positive influence from the higher power above. My youngest daughter is a clinical psychologist and had a difficult time retaining her pregnancy. Third, my family doctor made a lasting impression on me, and showed the importance of paying attention to every minute detail.
Mrunalini: What made you want to pursue an MS degree?
Dr. Caprini: My time in the military made me want to pursue a master’s degree. The stipend for being called into the military for service was $300 per month. I was drafted during the Vietnam war and operated on over 100 tonsillectomy patients at a military base in the US. Since I was worried about bleeding problems, I screened all of these patients for bleeding disorders and avoided surgery when the tests were abnormal. Using these screening techniques when I returned to Evanston Hospital, I was able to treat ⅓ of a group of bleeding patients without surgery. These screening techniques I used are still being followed at the hospital today.
Mrunalini: What challenges, if any, did you face in pursuing your education, especially with all the degrees and significant experiences that you have?
Dr. Caprini: I had no social life, so I got to know a nurse and shared knowledge and experience with each other. In order to be critical, you have to network.
I was very focused and planned my life accordingly. I didn’t have any fraternity life, but I had a great ambition to succeed in life. I had to sacrifice social life and used networking. I am now active at age 82 and have a strong mind. I was determined and wanted to help others, and share with others. Remember to always put yourself into others’ shoes.
Mrunalini: How has your time in the military impacted your education?
Dr. Caprini: This experience reinforced my decision to study bleeding and clotting disorders that became a life-long pursuit to these potentially life-threatening conditions.
Raina: What types of students have you taught?
Dr. Caprini: I had it in me to teach all the time; it was just my nature. When I learned about blood coagulation, I started teaching everyone in the medical group what I learned about blood coagulation as soon as I learned it. When I returned to Evanston Hospital, I started a research and clinical laboratory to study surgical hematology. More than 300 students who were graduates and undergraduates spent some time in the lab. One of them became an orthopedic surgeon. Now I work with some wonderful GTF students. I also have worked with many students on different levels conducting research, and writing papers.
Raina: Which subjects have you taught?
Dr. Caprini: I was asked to teach different courses. A typical session would last an hour and a half, and people would come sign up for it. They would come and we would do a lecture about stockings and give a demonstration applying removing stockings from patients. There were two parts to it, one was stockings and the other was compression wraps. The diagnosis, treatment, and prevention of venous thromboembolism (blood clots) has been my major teaching activity over the years.
Raina: What topics have you covered in the many lectures you’ve conducted?
Dr. Caprini: I stressed stating scientific data and applying it to clinical practice. I covered prophylaxis (prevention), most patients are complicated and do not exactly fit the guidelines.
Divya: What were your patient responsibilities?
Dr. Caprini: My very supportive and understanding wife always said to take care of the patients whenever I was going to be late coming home. I was very committed and dedicated to my patients and they will always be my primary responsibility.
Divya: What types of patients did you see?
Dr.Caprini: There were all sorts of surgeries (cancer, pediatric, vascular, etc) before the era of specialization began, after which my focus was vein surgery. For 25 years, there were various types of patients in the Caprini (Coagulation) lab.
Divya: What prompted you to come up with the Caprini Score?
Dr. Caprini: I found interest in a device called the thromboelastograph. This tool was introduced to the Caprini lab and led to several discoveries. The Kendal Corporation approached me because a doctor in England had invented compression boots which squeezed legs after surgery. They wanted me to use this test to look at the effect in stimulating the clot-dissolving enzymes that help prevent blood clots. These boots decrease the incidence of thrombosis by stimulating the blood and increasing blood flow out of the leg. I was invited to the first conference by the National Institutes of Health (NIH) to discuss the value of these devices. After the conference, I suggested to the Kendal corporation that they should sponsor a trial to show the value of these devices. They said it would cost too much but then three nurses, a PhD, and a physician from the company suggested that I create a list of risk factors that can cause a blood clot which ultimately led to the development of the Caprini Score.
What is a Caprini Score?
The Caprini Score is based on the Venous Thromboembolism Risk Factor Assessment that predicts risk and probability of VTE, defined as defined as deep vein thrombosis DVT or pulmonary embolism. There are 40 factors, and each factor has a weight of 1-5. Adding the number of risk factors and their weights yields a score. This score increases in parallel to the incidence of blood clots–a higher score predicts a higher incidence of blood clots. The idea is to take the Caprini Score ahead of time and share it with your physician. In case of injury, hospitalization, or need for surgery, the baseline score is available to the physicians. This will help them to determine if you need a blood thinner or the compression boots to prevent a blood clot.
Rashi: What exactly did you do in the search committee?
Dr. Caprini: These are 2 different committees we are talking about: the search committee and the IRB. I helped start the Institutional Review Board (IRB) in 1975. When people were conducting research, it became obvious that an overseer was needed to make sure the efficacy and safety parameters for the volunteers that are in the clinical trial are covered adequately for their safety. Someone may accidentally harm patients in their excitement of a new theory. Before they can take a drastic step, a peer review is needed. We picked a short list of potential reviewers after looking at all the credentials.
Rashi: Who is in the IRB?
Dr. Caprini: A typical IRB committee consists of physicians, scientists, administrators, and most importantly, an attorney, and one or more patient care advocates that are lay people.
Rashi. What is the purpose of the IRB?
Dr. Caprini: It exists for making sure that the protocol is followed properly and with patient’s safety of paramount importance. Clinical trials are conducted to avoid any bias between the control and the test groups.
Mrunalini: Did you choose to be a part of this committee (the Research and Education committee) or was it a part of your job?
Dr. Caprini: I was chosen based on my prior experience, and my time in the Vascular Lab.
Mrunalini: What research topics did the collected grant money go to?
Dr. Caprini: One of the exciting projects was to show how the anticoagulant heparin could inhibit cancer cells grown in a blood vessel from the placenta normally discarded after childbirth. Professor Shaker Mousa from the Albany College of Pharmacy and Health Sciences was an important consultant for this project.
Raina: What is the American Venous Forum?
Dr. Caprini: A small group of the most well-respected Vascular surgeons put together a society dedicated to the study and treatment of disorders of the venous system. The American Venous Forum has come to be the leading venous forum in the world, they have published many important papers and have done important research. I am going to donate the Caprini Score to the AVF. I want it to be renamed AVF Caprini Score and have all those young people continue to develop it and pass it forward.
Mrunalini: I understand that you were on the FDA review committee. What did you review on the FDA committee?
Dr. Caprini: The Blood Committee – The Food and Drug Committee on Blood Products reviewed factors in the blood such as platelet-rich plasma, platelet-poor plasma. They reviewed studies that were conducted using the blood products.
NIH (The National Institutes of Health) reviews grant proposals and give them an academic score and a funding score.
The board helped the NIH and Food and Drug Committee develop guidelines for general use.
Rashi: What is the BRIDGE Trial?
Dr. Caprini: The landmark BRIDGE (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation) trial provided high‐quality evidence that a simple interruption of warfarin in the average atrial fibrillation patient undergoing an elective procedure or surgery is noninferior to bridging therapy for efficacy and superior to bridging therapy in preventing major bleeding.
Divya: What were your main responsibilities as a member of the editorial board of American Heart Journal?
Dr. Caprini: American Heart Journal consisted of 3 reviewers and an Editor-in-Chief. The reviewers would look over the paper and leave comments/reviews and the Editor-in-Chief would look at all 3 reviews and decide if it’s in the running to be published. There was also the difficult job of selecting which papers went into the journal. The several papers that got turned down were usually well-written and thoughtful, but other papers had higher priority.
Take-home messages from the interview/conclusions:
Our interview clearly displayed the magnitude of Dr. Caprini’s many achievements.
- Dr. Caprini achieved a lot in a very short period. His ability to work hard, his determination, and his time-management skills helped him reach the high status of importance that he currently has.
- Dr. Caprini is a multi-talented and diverse physician who is well-respected by the community all over the World.
- Dr. Caprini has worked as a teacher, a surgeon, and a vascular specialist.
- Dr. Caprini is the author of many publications that he took the time to write and has received multiple research grants.
- The world knows him as the person who created the “Caprini Risk Score (CRS)”, which has been validated in more than 5 million patients involving more than 200 publications. The CRS allows high-risk patients to be identified so they can be protected from fatal thrombosis using anticoagulants.
- Everyone is encouraged to take the CRS and share it with his/her physician, so that in the future if you undergo surgery, the CRS could save your life.
We appreciate Dr. Caprini for speaking with us about his role in many different committees and publications, as well as how he got there. It was an honor to have interviewed Dr. Joseph Caprini. We would like to thank Dr. Laddu for mentoring us throughout this project, and Mrs. Shubhangi Bongirwar for helping us put the article together. We would also like to thank Dr. Caprini for giving us a moment from his schedule and sharing his advice.
About the Authors:
Rashi Modey – Rashi Modey is a rising sophomore at South Forsyth High school. She wishes to pursue a career in the hospitality and tourism industry.
Mrunalini Ghangrekar – Mrunalini Ghangrekar is a rising junior at West Forsyth High School. She has been with the Global Thrombosis Forum for about three years, and she hopes to continue to spread awareness about thrombosis while expanding her knowledge about the medical field. She wishes to pursue a career in the field of medicine.
Divya Honavar – Divya Honavar is a rising sophomore at Cambridge High School. She has been with the Global Thrombosis Forum for about 2 years. She wishes to have a career in the medical field, specifically a pediatrician.
Raina Singhal – Raina Singhal is a rising junior at Alpharetta High School. She has been with the Global Thrombosis Forum for nearly 2 years. She wishes to pursue a career as a medical surgeon.