Padua Prediction Score

Background

The Padua Prediction Score assesses venous thromboembolism (VTE) risk in hospitalised medical (non-surgical) patients to guide whether pharmacological thromboprophylaxis is appropriate. It weights eleven risk factors: active cancer, previous VTE, reduced mobility and known thrombophilia each score 3; recent trauma or surgery scores 2; and age ≥70, heart or respiratory failure, acute myocardial infarction or ischaemic stroke, acute infection or rheumatological disorder, obesity and ongoing hormonal treatment each score 1. The total separates patients into low and high risk.

Interpreting the result

A score of 0–3 indicates low VTE risk, where routine pharmacological prophylaxis is generally not warranted. A score of ≥4 indicates high risk, and prophylaxis should be considered after weighing the individual's bleeding risk and contraindications. The score guides a decision rather than mandating it; mechanical prophylaxis may be preferred when bleeding risk is high. Local thromboprophylaxis policy should always be followed.

Advice

A score ≥4 indicates high risk; weigh against bleeding risk and follow local thromboprophylaxis policy.

Worked example

A 75-year-old admitted with pneumonia who has active cancer (3), reduced mobility expected for several days (3) and age ≥70 (1) scores 7. This is well into the high-risk band, prompting consideration of pharmacological prophylaxis once bleeding risk has been assessed.

Pearls / pitfalls

• It applies to medical inpatients, not surgical patients, who need surgery-specific risk models.
• A high score is not an automatic indication to anticoagulate — bleeding risk must be assessed and may favour mechanical prophylaxis.
• Reduced mobility refers to anticipated bedrest for at least three days, not a brief admission.
• It is a one-off admission assessment; reassess if the clinical situation changes during the stay.

Evidence & validation

Derived and validated prospectively by Barbar and colleagues, demonstrating a much higher VTE incidence in high-risk patients not given prophylaxis. It is referenced in international guidance, including the American College of Chest Physicians antithrombotic guidelines, as a risk-assessment model for medical inpatients.

Frequently asked questions

References

1. 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.
2. NICE NG89: Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. 2018.

About the creator

Barbar S et al.

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