Interactive tool
Calculate the Padua Prediction Score
Tick the factors present at admission. The high-risk threshold is ≥ 4 points.
How to use it
Instructions
Who it applies to
Adult patients admitted for an acute medical illness: heart failure, respiratory failure, acute infection, active rheumatic disease, ischaemic stroke, cancer. It is not validated in surgical patients (use Caprini), in outpatients or in pregnancy.
Notes on the criteria
- Active cancer (3 points): local or distant metastases, or chemotherapy or radiotherapy in the previous 6 months.
- Previous venous thromboembolism (3 points): DVT or pulmonary embolism. Superficial vein thrombosis is excluded from this criterion.
- Reduced mobility (3 points): bed rest with bathroom privileges only, expected or already present, for at least 3 days. This is the criterion most often overestimated: a patient who walks around the ward does not meet it.
- Already known thrombophilia (3 points): antithrombin, protein C or S deficiency, factor V Leiden, prothrombin G20210A mutation, antiphospholipid syndrome. The criterion requires an already documented diagnosis: it should not be ticked on suspicion, and the score is not an indication for thrombophilia screening.
- Recent trauma or surgery (2 points): within one month.
- Obesity (1 point): BMI ≥ 30. Note that the threshold differs from Caprini's, which uses BMI > 25.
- Ongoing hormonal treatment (1 point): hormonal contraception or hormone replacement therapy.
When to reassess
The score should be recalculated if the clinical situation changes: a new infection, bed rest lasting longer than expected or a cancer diagnosis made during the admission can move a patient from low to high risk. Likewise, a return to independent walking may justify stopping prophylaxis.
A Padua score ≥ 4 identifies a candidate for pharmacological prophylaxis, but the decision requires a parallel assessment of bleeding risk (IMPROVE Bleeding score, active bleeding, platelets < 50×109/L, active gastroduodenal ulcer, severe hepatic or renal failure). When bleeding risk prevails, mechanical prophylaxis is used.
Clinical references
Guidelines and interpretation
| Score | Class | VTE at 90 days without prophylaxis | Management |
|---|---|---|---|
| < 4 | Low risk | ~0.3% | No pharmacological prophylaxis; early mobilisation and hydration |
| ≥ 4 | High risk | ~11.0% | Pharmacological prophylaxis with LMWH, unfractionated heparin or fondaparinux for the whole hospital stay |
The data come from the prospective validation cohort (Barbar S. et al., J Thromb Haemost 2010): 1180 medical patients followed up for 90 days. Among high-risk patients who did not receive prophylaxis the incidence of venous thromboembolism was 11.0%, compared with 2.2% in those who did; among low-risk patients the incidence was 0.3%.
What the guidelines say
- ACCP (Chest 2012): recommends using a risk assessment model in medical patients and explicitly cites the Padua Prediction Score, with pharmacological prophylaxis in high-risk patients and no prophylaxis in low-risk patients (grade 1B/2B).
- ASH 2018: recommends prophylaxis with LMWH or unfractionated heparin in acutely ill medical patients at increased risk, preferring LMWH because of its less frequent dosing and lower risk of HIT.
- SIAPAV / FCSA (Italian societies): adopt the risk-model approach in hospitalised medical patients.
Prophylaxis: indicative regimens
| Drug | Usual prophylactic dose | Notes |
|---|---|---|
| Enoxaparin | 4000 IU (40 mg) s.c. / 24 h | Reduce to 2000 IU (20 mg) / 24 h if creatinine clearance < 30 ml/min |
| Nadroparin | 3800 IU s.c. / 24 h | Adjust to body weight |
| Dalteparin | 5000 IU s.c. / 24 h | |
| Fondaparinux | 2.5 mg s.c. / 24 h | Contraindicated if clearance < 20 ml/min; useful in HIT |
| Unfractionated heparin | 5000 IU s.c. every 8–12 h | Preferred in severe renal failure |
Doses are indicative: always check the current summary of product characteristics and adjust to body weight, renal function and platelet count.
Duration
Prophylaxis is continued for the whole hospital stay and until independent mobility is regained, usually 6–14 days. Extended prophylaxis after discharge is not routinely recommended in medical patients: trials with rivaroxaban (MAGELLAN), apixaban (ADOPT) and betrixaban (APEX) showed fewer events, offset by more major bleeding. In selected subgroups at very high thrombotic risk and low bleeding risk — identified for example with IMPROVEDD — the balance may be favourable.
Padua or IMPROVE?
The two models answer the same question in different ways: Padua is more sensitive and classifies a larger proportion of patients as high risk (about 40% in the validation cohorts), while IMPROVE is more specific and restrictive. In practice Padua is preferred when the aim is not to miss candidates for in-hospital prophylaxis, and IMPROVE when deciding on extended prophylaxis after discharge, where bleeding risk carries more weight.
References
Sources
- Barbar S. et al., J Thromb Haemost 2010 — A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score.
- Kahn SR. et al., Chest 2012 (ACCP 9th ed.) — Prevention of VTE in nonsurgical patients.
- Schünemann HJ. et al., Blood Adv 2018 (ASH) — American Society of Hematology 2018 guidelines for management of VTE: prophylaxis for hospitalized and nonhospitalized medical patients.
- Cohen AT. et al., N Engl J Med 2013 / 2016 — MAGELLAN and APEX trials on extended prophylaxis in medical patients.
Quick-reference tool for healthcare professionals. It does not replace the original guidelines, the summaries of product characteristics or the specialist's clinical judgement. All calculations run in the browser: no patient data is transmitted to or stored on any server.