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Instructions

Apply to acutely ill adult medical inpatients admitted for any reason except surgery, trauma, obstetrics, or planned procedures.
Use at the time of admission and again if the patient’s clinical status changes significantly during hospitalization.
The tool is not appropriate for use in outpatient populations or for patients in specialized pathways outside of general medical care.
Not validated for use in surgical, obstetric, or trauma populations.

Risk factors

Cardiac failure

NoYes

Introduction

The Geneva Risk Score is a validated risk assessment tool that helps clinicians decide which hospitalized medical patients need pharmacologic prophylaxis against venous thromboembolism (VTE). It was developed by Dr. Pierre Chopard and colleagues (2006) at the University Hospitals of Geneva and later validated in the multicentre ESTIMATE study (Nendaz et al., 2014). The score sums weighted points across 19 risk factors, up to a maximum of 30 points, covering acute illnesses (such as cardiac or respiratory failure and infection), prior VTE and thrombophilia, cancer, reduced mobility, and patient characteristics such as age and BMI. A score of 3 or more identifies high-risk patients for whom prophylaxis is generally indicated, while a score below 3 suggests prophylaxis is not routinely needed. It is distinct from the revised Geneva Score used to estimate the probability of pulmonary embolism in patients with suspected PE, and, like other VTE risk scores, it is meant to support rather than replace clinical judgment and a separate bleeding risk assessment.

Scoring

Sum of the selected points.

Variable	Points
Cardiac failure	2
Respiratory failure	2
Recent stroke (<3 months ago)	2
Recent myocardial infarction (<4 weeks ago)	2
Acute infectious disease (including sepsis)	2
Acute rheumatic disease	2
Active malignancy	2
Myeloproliferative syndrome	2
Nephrotic syndrome	2
History of venous thromboembolism	2
Known hypercoagulable state	2
Immobilization (<30 min walking per day) for ≥3 days	1
Recent travel for >6 hrs	1
Age >60 years	1
BMI >30 kg/m²	1
Chronic venous insufficiency	1
Pregnancy	1
Hormonal therapy (contraceptive or replacement therapy)	1
Dehydration	1

Results

Geneva Score for VTE Prophylaxis	Risk Group	Risk of VTE*	Recommendation
<3	Low	0.6%	No VTE prophylaxis indicated
≥3	High	3.2%	VTE prophylaxis indicated

*Composite endpoint of symptomatic VTE or VTE-related death at 90 days. From Nendaz 2014.

Management Considerations

This tool does not account for all individual risk factors; use it as part of a comprehensive risk assessment.
Weigh bleeding risk before considering anticoagulants. Tools, such as IMPROVE Bleeding Risk Score or VTE-BLEED Score can assist with decision-making.
Reassess the score if the patient’s clinical status changes.
Consider addressing modifiable risk factors for bleeding.
Risk and benefits of anti-coagulation should be considered in patients, to include shared decision-making and informed consent, prior to initiating therapy.
Clinical judgement and best practice guidelines supersede adjunct standalone decision tools. Refer to local protocols and guidelines for specific prophylaxis regimens and monitoring.

Clinical Guidelines

All questions & possible results

Risk factors

Cardiac failure

Select one option:

Respiratory failure

Select one option:

Recent stroke (<3 months)

Select one option:

Recent myocardial infarction (<4 weeks)

Select one option:

Acute infectious disease (including sepsis)

Select one option:

Acute rheumatic disease

Select one option:

Active malignancy

Select one option:

Myeloproliferative syndrome

Select one option:

Nephrotic syndrome

Select one option:

Any prior venous thromboembolism (VTE)

Select one option:

Known hypercoagulable state

Select one option:

Immobilization (≥3 days)

<30min of walking per day

Select one option:

Recent travel for >6 hours

Select one option:

Age >60 years

Select one option:

BMI >30kg/m²

BMI Calculator

Select one option:

Chronic venous insufficiency

Select one option:

Pregnancy

Select one option:

Hormonal therapy

Contraceptive or replacement therapy

Select one option:

Dehydration

Select one option:

Possible results

Geneva Risk Score for VTE Prophylaxis: 3.2% VTE Risk* & HIGH risk - VTE prophylaxis indicated (if no contraindications)

Management Considerations

Initiate pharmacologic prophylaxis per local protocol (e.g., LMWH/UFH) after bleeding-risk assessment.
Emphasize early mobilization and consider mechanical prophylaxis (e.g., compression stockings) when pharmacologic agents are contraindicated or insufficient.
This tool does not account for all individual risk factors; use it as part of a comprehensive risk assessment.
Weigh bleeding risk before considering anticoagulants. Tools, such as IMPROVE Bleeding Risk Score or VTE-BLEED Score can assist with decision-making.
Reassess the score if the patient’s clinical status changes.
Consider addressing modifiable risk factors for bleeding.
Risk and benefits of anti-coagulation should be considered in patients, to include shared decision-making and informed consent, prior to initiating therapy.
Clinical judgement and best practice guidelines supersede adjunct standalone decision tools. Refer to local protocols and guidelines for specific prophylaxis regimens and monitoring.

Clinical Guidelines

*Composite endpoint of symptomatic VTE or VTE-related death at 90 days. From Nendaz 2014.

Geneva Risk Score for VTE Prophylaxis: 0.6% VTE Risk* & LOW risk - VTE prophylaxis NOT indicated

Management Considerations

Routine pharmacologic thromboprophylaxis is generally NOT indicated.
Emphasize early mobilization and consider non-pharmacologic measures (e.g., compression stockings) if clinically indicated.
This tool does not account for all individual risk factors; use it as part of a comprehensive risk assessment.
Weigh bleeding risk before considering anticoagulants. Tools, such as IMPROVE Bleeding Risk Score or VTE-BLEED Score can assist with decision-making.
Reassess the score if the patient’s clinical status changes.
Consider addressing modifiable risk factors for bleeding.
Risk and benefits of anti-coagulation should be considered in patients, to include shared decision-making and informed consent, prior to initiating therapy.
Clinical judgement and best practice guidelines supersede adjunct standalone decision tools. Refer to local protocols and guidelines for specific prophylaxis regimens and monitoring.

Clinical Guidelines

*Composite endpoint of symptomatic VTE or VTE-related death at 90 days. From Nendaz 2014.

Citation

Chopard P, Spirk D, Bounameaux H. Identifying acutely ill medical patients requiring thromboprophylaxis. J Thromb Haemost. 2006 Apr;4(4):915-6.

Literature

Chopard P, Spirk D, Bounameaux H. Identifying acutely ill medical patients requiring thromboprophylaxis. J Thromb Haemost. 2006 Apr;4(4):915-6.
https://pubmed.ncbi.nlm.nih.gov/16634771/
Nendaz M, Spirk D, Kucher N, Aujesky D, Hayoz D, Beer JH, Husmann M, Frauchiger B, Korte W, Wuillemin WA, Jäger K, Righini M, Bounameaux H. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost. 2014 Mar 3;111(3):531-8.
https://pubmed.ncbi.nlm.nih.gov/24226257/
Cobben M, Nemeth B, Lijfering W, et al. Validation of risk assessment models for venous thrombosis in hospitalized medical patients Research and Practice in Thrombosis and Haemostasis, 3, 217-225
https://www.rpthjournal.org/article/S2475-0379(22)01529-1/fulltext
Pandor A, Tonkins M, Goodacre S, Sworn K, Clowes M, Griffin XL, Holland M, Hunt BJ, de Wit K, Horner D. Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review. BMJ Open. 2021 Jul 29;11(7):e045672.
https://pubmed.ncbi.nlm.nih.gov/34326045/
Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e195S-e226S.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3278052/
Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, Rezende SM, Zakai NA, Bauer KA, Dentali F, Lansing J, Balduzzi S, Darzi A, Morgano GP, Neumann I, Nieuwlaat R, Yepes-Nuñez JJ, Zhang Y, Wiercioch W. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018 Nov 27;2(22):3198-3225. doi: 10.1182/bloodadvances.2018022954. Erratum in: Blood Adv. 2023 May 09;7(9):1671.
https://pubmed.ncbi.nlm.nih.gov/30482763/
Anderson FA Jr, Zayaruzny M, Heit JA, Fidan D, Cohen AT. Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol. 2007 Sep;82(9):777-82.
https://pubmed.ncbi.nlm.nih.gov/17626254/
Nendaz MR, Chopard P, Lovis C, Kucher N, Asmis LM, Dörffler J, Spirk D, Bounameaux H. Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems. J Thromb Haemost. 2010 Jun;8(6):1230-4.
https://pubmed.ncbi.nlm.nih.gov/20175871/
Darzi AJ, Repp AB, Spencer FA, Morsi RZ, Charide R, Etxeandia-Ikobaltzeta I, Bauer KA, Burnett AE, Cushman M, Dentali F, Kahn SR, Rezende SM, Zakai NA, Agarwal A, Karam SG, Lotfi T, Wiercioch W, Waziry R, Iorio A, Akl EA, Schünemann HJ. Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews. Blood Adv. 2020 Oct 13;4(19):4929-4944.
https://pubmed.ncbi.nlm.nih.gov/33049056/

Risk factors

All questions & possible results

Citation

Literature

Related evaluations

Caprini Score for Venous Thromboembolism (2005)

IMPROVEDD Risk Score for VTE

IMPROVE Risk Score for VTE

VTE-BLEED Score

Padua Prediction Score for Risk of VTE

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