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Padua Prediction Score (VTE)

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Mikä on Padua Prediction Score (VTE)?

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The Padua Prediction Score is a validated VTE risk stratification tool designed specifically for acutely ill medical inpatients, developed by Barbar and colleagues at the University Hospital of Padua, Italy, and published in the Journal of Thrombosis and Haemostasis in 2010. Unlike the Caprini RAM (which was developed for surgical patients), the Padua Score was derived from and validated in a cohort of medical patients hospitalised for acute illness, making it the most widely cited VTE risk assessment tool for non-surgical inpatients. The score assigns weighted points to 11 clinical risk factors: active cancer (3 points), prior VTE (3 points), reduced mobility defined as bed rest for at least 3 days due to patient limitations or physician order (3 points), already known thrombophilic condition (3 points), recent trauma or surgery within 30 days (2 points), age 70 years or older (1 point), heart or respiratory failure (1 point), acute myocardial infarction or ischaemic stroke (1 point), active infectious or rheumatological disorder (1 point), obesity defined as BMI greater than 30 (1 point), and current hormonal treatment (1 point). A total score of 4 or more defines high risk, with a VTE rate of approximately 11% at 90 days without prophylaxis compared to 0.3% in low-risk patients. High-risk patients should receive pharmacological thromboprophylaxis with LMWH unless contraindicated. The Padua Score is included in NHS England VTE assessment tools and is endorsed by national and international clinical guidelines for acutely ill medical patients.

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f(x)

Padua Score = cancer(3) + prior VTE(3) + reduced mobility(3) + thrombophilia(3) + trauma/surgery ≤30d(2) + age ≥70(1) + HF/RF(1) + MI/stroke(1) + infection/rheum(1) + obesity BMI>30(1) + hormonal(1); ≥4 = high risk

Kuinka Padua Prediction Score (VTE)

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1Step 1 — Active cancer: Score 3 if patient has active malignancy (local or distant metastases) and/or received chemotherapy or radiotherapy within 30 days.
2Step 2 — Prior VTE: Score 3 if the patient has a previous documented DVT or PE (excluding superficial vein thrombosis).
3Step 3 — Reduced mobility: Score 3 if the patient has reduced mobility due to bed rest for at least 3 days, either from patient's own limitations or physician-ordered bed rest.
4Step 4 — Thrombophilic condition: Score 3 if a known thrombophilic condition is documented (antithrombin deficiency, protein C/S deficiency, Factor V Leiden, prothrombin G20210A, antiphospholipid syndrome).
5Step 5 — Recent trauma or surgery: Score 2 if the patient has had trauma or surgery within the past 30 days.
6Step 6 — One-point factors: Score 1 each for age ≥70, heart or respiratory failure, recent MI or ischaemic stroke, active infection or rheumatological disorder, obesity (BMI >30), and ongoing hormonal treatment (oral contraceptive, HRT).
7Step 7 — Interpret total: Score <4 = low risk (~0.3% VTE rate) — no routine prophylaxis, consider ambulation; Score ≥4 = high risk (~11% VTE rate) — initiate pharmacological thromboprophylaxis (LMWH 40 mg OD enoxaparin or equivalent) unless bleeding risk is high.

Ratkaistut esimerkit

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Esimerkki 1Elderly Cancer Patient — High Risk

Annettu:72-year-old with active colorectal cancer, bed-ridden after surgery 3 weeks ago

Tulos:Padua Score = 3+1+3+2 = 9 (High Risk — start LMWH prophylaxis)

Very high VTE risk; enoxaparin 40 mg SC OD; consider extended prophylaxis post-discharge

Active cancer=3, age ≥70=1, reduced mobility=3, recent surgery ≤30d=2. Total=9 — well above the ≥4 threshold for high risk.

Esimerkki 2Pneumonia Patient — Low Risk

Annettu:55-year-old with community-acquired pneumonia, ambulatory, no significant medical history

Tulos:Padua Score = 1 (Low Risk — pharmacological prophylaxis not indicated by score)

Encourage early ambulation; reassess if mobility deteriorates or new risk factors develop

Active infection=1. Total=1 — below the ≥4 threshold. Routine LMWH prophylaxis not indicated, though local guidelines and individual assessment apply.

Esimerkki 3Heart Failure Patient with Prior DVT

Annettu:68-year-old with CHF exacerbation, history of DVT 2 years ago, BMI 32, on HRT

Tulos:Padua Score = 1+3+1+1 = 6 (High Risk — start LMWH)

Multiple risk factors compound; enoxaparin 40 mg SC OD; reassess renal function for dose adjustment

HF=1, prior VTE=3, BMI>30=1, hormonal=1. Total=6. High risk threshold met. Enoxaparin 40 mg OD unless eGFR <30 (use UFH then).

Esimerkki 4Stroke Patient — High Risk Despite Few Factors

Annettu:75-year-old with acute ischaemic stroke, immobile, no prior VTE or cancer

Tulos:Padua Score = 1+1+3 = 5 (High Risk)

Stroke patients are at very high VTE risk; mechanical prophylaxis initially if haemorrhagic transformation risk; LMWH when safe

Ischaemic stroke=1, age ≥70=1, reduced mobility=3. Total=5. In haemorrhagic stroke, defer LMWH — use IPC devices until safe to anticoagulate.

Käytännön sovellukset

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NHS hospital VTE CQUIN assessment — mandatory VTE risk assessment tool for all medical admissions, representing an important application area for the Padua Prediction in professional and analytical contexts where accurate padua prediction calculations directly support informed decision-making, strategic planning, and performance optimization

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General medical and respiratory ward prophylaxis decision-making for acute illness inpatients, representing an important application area for the Padua Prediction in professional and analytical contexts where accurate padua prediction calculations directly support informed decision-making, strategic planning, and performance optimization

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Pharmacist-led VTE prescribing review to ensure appropriate LMWH is prescribed in high-risk patients, representing an important application area for the Padua Prediction in professional and analytical contexts where accurate padua prediction calculations directly support informed decision-making, strategic planning, and performance optimization

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Quality improvement audits measuring compliance with NICE NG89 VTE prevention recommendations, representing an important application area for the Padua Prediction in professional and analytical contexts where accurate padua prediction calculations directly support informed decision-making, strategic planning, and performance optimization

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Medical student and junior doctor education on systematic risk factor identification in hospitalised patients, representing an important application area for the Padua Prediction in professional and analytical contexts where accurate padua prediction calculations directly support informed decision-making, strategic planning, and performance optimization

Erikoistapaukset

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Haemorrhagic Stroke

{'title': 'Haemorrhagic Stroke', 'body': 'Haemorrhagic stroke patients have high VTE risk from immobility but are at significant risk of haematoma expansion with anticoagulation. LMWH should be deferred until haemostasis is confirmed (usually 24–48 hours from symptom onset after neurosurgery review). Intermittent pneumatic compression (IPC) devices should be applied from admission as mechanical prophylaxis.'}

Patients with Thrombocytopenia

{'title': 'Patients with Thrombocytopenia', 'body': 'In patients with platelet count 50–100 × 10^9/L, the decision to use LMWH requires balancing VTE risk against bleeding risk. Below 50 × 10^9/L, LMWH is generally withheld and mechanical prophylaxis used. Haematology input is advisable. Thrombocytopenia due to HIT absolutely contraindicates all heparin products.'}

Patients with Prior Intracerebral Haemorrhage

{'title': 'Patients with Prior Intracerebral Haemorrhage', 'body': 'A history of intracranial haemorrhage increases bleeding risk significantly. Pharmacological VTE prophylaxis is relatively contraindicated. Graduated compression stockings and IPC devices are the mainstay. In some high-risk situations, the benefit of LMWH may outweigh risk and a case-by-case decision with neurology and haematology is required.'}

Palliative Care Patients

{'title': 'Palliative Care Patients', 'body': 'In terminally ill patients, VTE risk must be weighed against the burden of daily injections, bleeding risk from potential disease-related coagulopathy, and patient preferences. The Padua Score does not incorporate prognosis or quality-of-life considerations. Shared decision-making with patient and family about the goals of prophylaxis is essential in palliative contexts.'}

Padua Prediction Score Risk Factors

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Risk Factor	Points
Active cancer	3
Prior VTE (DVT or PE)	3
Reduced mobility (bed rest ≥3 days)	3
Known thrombophilic condition	3
Recent trauma or surgery (≤30 days)	2
Age ≥70 years	1
Heart failure or respiratory failure	1
Acute MI or ischaemic stroke	1
Active infection or rheumatological disorder	1
Obesity (BMI >30)	1
Ongoing hormonal treatment	1
TOTAL ≥4 = High Risk	→ LMWH prophylaxis

Usein kysytyt kysymykset

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How does the Padua Score differ from the Caprini RAM?

The Padua Score is specifically validated for acutely ill medical (non-surgical) inpatients and uses 11 simpler risk factors, making it practical for bedside ward assessment. The Caprini RAM was validated for surgical patients and includes over 40 risk factors across more granular surgical and patient-specific categories. For non-surgical inpatients, Padua is preferred; for perioperative risk assessment, Caprini is more appropriate.

Is reduced mobility clearly defined in the Padua Score?

In the original Padua validation, reduced mobility was defined as anticipated bed rest for at least 3 days due to patient limitations (pain, disability, weakness) or physician order. Patients who are mobile within the hospital ward (walking to bathroom, physiotherapy sessions) are not classified as having reduced mobility for scoring purposes.

How should Padua Score be used with IMPROVE and other scores?

The IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) VTE Risk Score is another validated tool for medical inpatients. Both tools have similar performance but different risk factors and thresholds. Local institutional guidelines typically adopt one primary tool. The key principle is consistent systematic risk assessment at admission rather than the specific tool used.

What LMWH dose is standard for Padua high-risk patients?

Standard prophylactic LMWH: enoxaparin 40 mg SC once daily (or 20 mg in severe renal impairment), dalteparin 5,000 units SC once daily, or tinzaparin 3,500 units SC once daily. All doses should be reduced if eGFR <30 mL/min. Anti-Xa monitoring may be considered in obesity (BMI >40) or renal impairment.

Does the Padua Score apply to ICU patients?

The Padua Score was validated in general medical ward inpatients, not ICU patients. ICU patients are universally considered high VTE risk due to immobility, critical illness, central venous catheters, and other factors. SCCM guidelines recommend universal VTE prophylaxis in ICU patients regardless of formal risk scoring. The SOFA score and clinical assessment guide ICU management.

Yleisiä virheitä vältettäväksi

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!Confusing reduced mobility criterion — only bed rest for ≥3 days qualifies, not simply being 'not very active'.
!Not reassessing Padua Score during the inpatient stay — new developments (surgery, infection, immobility) may change the category.
!Using Caprini Score for medical inpatients where Padua is more appropriate and validated.
!Prescribing LMWH without checking renal function — accumulation in eGFR <30 causes clinically significant bleeding risk.
!Forgetting that HRT and COCP contribute 1 point — commonly overlooked medications that incrementally increase risk.
!Applying Padua in ICU patients where universal prophylaxis guidelines supersede individual risk scoring.

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Ammattilaisen vinkki

In a typical acute medical admission, quickly sum the 3-point factors first: active cancer, prior VTE, reduced mobility, and thrombophilia. If any two of these are present, the patient scores ≥6 and is high risk without needing to check the 1-point factors. For most ward patients, the key question is: is there cancer, prior VTE, or will they be bed-bound for ≥3 days?

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Tiesitkö?

The Padua Prediction Score was developed after the MEDENOX trial (1999) showed that enoxaparin prophylaxis reduced VTE risk in acutely ill medical patients by 63%, yet studies consistently showed that fewer than 50% of eligible inpatients were receiving appropriate thromboprophylaxis. The Padua Score was designed to systematise and improve this process — and since its publication in 2010, it has been adopted as a standard quality indicator across hundreds of hospitals worldwide.

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