Padua Risk

The Padua Prediction Score estimates whether a patient admitted for a medical (non-surgical) illness is at high or low risk of deep vein thrombosis and pulmonary embolism.

How the calculation works

The score was developed at the University of Padua and published by Barbar et al. in the Journal of Thrombosis and Haemostasis in 2010. The ACCP guidelines (CHEST, 2012) recommend it for VTE risk assessment in hospitalized medical patients; surgical patients are assessed with other tools such as the Caprini score.

Three points each: active cancer (local or distant metastases and/or chemotherapy or radiotherapy in the previous 6 months), previous VTE (excluding superficial vein thrombosis), reduced mobility for at least 3 days, and a known thrombophilic condition (antithrombin, protein C or S deficiency, factor V Leiden, prothrombin G20210A mutation, antiphospholipid syndrome). Two points: trauma or surgery within the last month. One point each: age 70 or older, heart and/or respiratory failure, acute myocardial infarction or ischemic stroke, acute infection and/or rheumatologic disorder, obesity (BMI ≥ 30) and ongoing hormonal treatment.

Each factor is entered as 1 (present) or 0 (absent); age is entered in years. A total of 4 or more means high risk, where thromboprophylaxis is generally indicated unless contraindicated. Below 4 is low risk, where prophylaxis is usually not needed.

Worked example

Defaults: a 60-year-old patient with active cancer (3 points) and reduced mobility for at least 3 days (3 points), with no other factors. The total of 6 points means high VTE risk, and prophylaxis is indicated if there are no contraindications. If the same patient were mobile, the total would be 3 points, which is low risk.

Things to keep in mind

• Bleeding risk should be assessed before prophylaxis (for example with the IMPROVE bleeding score); a high Padua score alone does not make anticoagulation safe.
• Risk changes during a stay: recalculate after a new infection, immobilization or surgery.
• In the original study, reduced mobility meant bed rest with bathroom privileges for at least 3 days, not merely reduced activity.
• This is a reference tool. The decision on prophylaxis, the drug and the dose belong to the treating physician.