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Padua Prediction Score for Risk of VTE

Determines anticoagulation need in hospitalized patients by risk of VTE.

CreatorDr. Sofia Barbar, MD
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Instructions

  • May be applied to patients hospitalized for non-surgical medical diagnoses who have the potential risk of VTE.

Local or distant metastases and/or chemotherapy or radiotherapy in the previous 6 months.

Padua Prediction Score

The Padua Prediction Score is a validated risk assessment model used to identify hospitalized medical (non-surgical) patients at risk for venous thromboembolism (VTE), helping determine who needs pharmacologic thromboprophylaxis during admission. The Padua Prediction score assesses the risk of clot formation in acutely ill medical inpatients.

Development

The score was developed by Barbar et al. (Journal of Thrombosis and Haemostasis, 2010) in a cohort of 1,180 hospitalized medical patients. It was designed to distinguish high-risk from low-risk patients so that thromboprophylaxis could be targeted appropriately rather than applied indiscriminately.

The 11 Components (20 possible points)

Risk Factor

Points

Active cancer (metastases and/or chemo/radiotherapy in the previous 6 months)

3

Previous VTE (excluding superficial vein thrombosis)

3

Reduced mobility (bedrest ≥3 days)

3

Known thrombophilic condition

3

Recent (≤1 month) trauma and/or surgery

2

Elderly age (≥70 years)

1

Heart and/or respiratory failure

1

Acute myocardial infarction or ischemic stroke

1

Acute infection and/or rheumatologic disorder

1

Obesity (BMI ≥30 kg/m²)

1

Ongoing hormonal treatment

1

Risk Categories and Outcomes

Score

Risk Category

VTE Incidence (without prophylaxis)

<4

Low risk - Pharmacologic thromboprophylaxis is generally not indicated but ought to be considered on a case-by-case basis. Consider mechanical prophylaxis if bleeding risk is high.

~0.3%

≥4

High risk - Pharmacologic (e.g., heparin, enoxaparin) and/or mechanical thromboprophylaxis for non-pregnant patients is generally indicated in the absence of contraindications (major bleeding, low platelets, creatinine clearance <30mL/min) who are >18years. Consider mechanical prophylaxis if bleeding risk is high.

~11%

In the original derivation study, this translated into a striking separation: high-risk patients without prophylaxis had roughly a 32-fold higher hazard of VTE compared to low-risk patients. Among high-risk patients who did receive thromboprophylaxis, bleeding occurred in only about 1.6% — supporting a favorable risk-benefit profile for treating the high-risk group.

Clinical Use

A score of ≥4 points is the actionable threshold: these patients are generally recommended for pharmacologic prophylaxis (commonly low-molecular-weight heparin such as enoxaparin, or a DOAC), provided bleeding risk doesn't contraindicate it. Patients scoring below 4 are considered low risk and typically don't require pharmacologic prophylaxis, avoiding unnecessary anticoagulant exposure and bleeding risk.

  • Consider institutional guidance, clinical guidelines, and clinical judgment which supersedes adjunct standalone decision tools.

  • Risk and benefits of anti-coagulation should be considered in patients, to include shared decsion-making and informed consent, prior to initiating therapy. 

  • Consider addressing modifiable risk factors for bleeding.

Clinical Guidelines

All questions & possible results

Padua Risk FactorsTitle not visible
Active cancer
Local or distant metastases and/or chemotherapy or radiotherapy in the previous 6 months.

Select one option:

  • No
  • Yes
Previous VTE

  • Excluding superficial vein thrombosis.

Select one option:

  • No
  • Yes
Reduced mobility

Select one option:

  • No
  • Yes
Already known thrombophilic condition

  • Defects of antithrombin, protein C or S, factor V Leiden, G20210A prothrombin mutation, or antiphospholipid syndrome.

Select one option:

  • No
  • Yes
Recent (≤ 1 month) trauma and/or surgery

Select one option:

  • No
  • Yes
Elderly age (≥70 years)

Select one option:

  • No
  • Yes
Heart and/or respiratory failure

Select one option:

  • No
  • Yes
Acute myocardial infarction and/or ischemic stroke

Select one option:

  • No
  • Yes
Acute infection and/or rheumatologic disorder

Select one option:

  • No
  • Yes
Obesity (BMI ≥30)

Select one option:

  • No
  • Yes
Ongoing hormonal treatment

Select one option:

  • No
  • Yes
Possible results
Low risk of VTE (score <4): Pharmacologic prophylasix is NOT indicated.

  • A score under 4 points indicates low risk of venous thromboembolism in this hospitalized medical patient.

  • In the original derivation cohort, VTE occurred in about 0.3% of low-risk patients not given prophylaxis.

  • Pharmacologic thromboprophylaxis is generally not indicated but ought to be considered on a case-by-case basis. Consider mechanical prophylaxis if bleeding risk is high.

  • Consider institutional guidance, clinical guidelines, and clinical judgment which supersedes adjunct standalone decision tools.

  • Risk and benefits of anti-coagulation should be considered in patients, to include shared decsion-making and informed consent, prior to initiating therapy. 

  • Consider addressing modifiable risk factors for bleeding.

Clinical Guidelines

High risk of VTE (score ≥4 ): Pharmacologic prophylaxis IS indicated.

  • A score of 4 points or more indicates high risk of venous thromboembolism in this hospitalized medical patient.

  • In the original derivation cohort, VTE occurred in about 11% of high-risk patients not given prophylaxis.

  • Pharmacologic (e.g., heparin, enoxaparin) and/or mechanical thromboprophylaxis for non-pregnant patients is generally indicated in the absence of contraindications (major bleeding, low platelets, creatinine clearance <30mL/min) who are >18years. Consider mechanical prophylaxis if bleeding risk is high.

  • Consider institutional guidance, clinical guidelines, and clinical judgment which supersedes adjunct standalone decision tools.

  • Risk and benefits of anti-coagulation should be considered in patients, to include shared decsion-making and informed consent, prior to initiating therapy. 

  • Consider addressing modifiable risk factors for bleeding.

Clinical Guidelines

Citation

Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-2457.

Literature

  • Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010 Nov;8(11):2450-7.

    https://pubmed.ncbi.nlm.nih.gov/20738765/

  • Vardi M, Ghanem-Zoubi NO, Zidan R, Yurin V, Bitterman H. Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost. 2013 Mar;11(3):467-73.

    https://pubmed.ncbi.nlm.nih.gov/23279085/

  • 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/

  • Greene MT, Spyropoulos AC, Chopra V, Grant PJ, Kaatz S, Bernstein SJ, Flanders SA. Validation of Risk Assessment Models of Venous Thromboembolism in Hospitalized Medical Patients. Am J Med. 2016 Sep;129(9):1001.e9-1001.e18.

    https://pubmed.ncbi.nlm.nih.gov/27107925/

  • Germini F, Agnelli G, Fedele M, Galli MG, Giustozzi M, Marcucci M, Paganelli G, Pinotti E, Becattini C. Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis: a quasi-randomized controlled trial. J Thromb Thrombolysis. 2016 Oct;42(3):336-9.

    https://pubmed.ncbi.nlm.nih.gov/27052516/

  • Moumneh T, Riou J, Douillet D, Henni S, Mottier D, Tritschler T, Le Gal G, Roy PM. Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study. J Thromb Haemost. 2020 Jun;18(6):1398-1407.

    https://pubmed.ncbi.nlm.nih.gov/32168402/

  • Arakaki D, Iwata M, Terasawa T. External Validation of the Padua and IMPROVE-VTE Risk Assessment Models for Predicting Venous Thromboembolism in Hospitalized Adult Medical Patients: A Retrospective Single-Center Study in Japan. Ann Vasc Dis. 2023 Mar 25;16(1):60-68.

    https://pubmed.ncbi.nlm.nih.gov/37006863/

  • 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/

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