PADUA Prediction Score
Select all risk factors present for your hospitalized medical patient. A score ≥4 indicates high VTE risk.
Active cancer
+3Active malignancy (treatment ongoing, within 6 months, or palliative)
Previous VTE
+3History of deep vein thrombosis or pulmonary embolism (excluding superficial vein thrombosis)
Reduced mobility
+3Bed rest ≥3 days or major surgery requiring general/regional anesthesia
Already known thrombophilic condition
+3Inherited or acquired thrombophilia (e.g., Factor V Leiden, antiphospholipid syndrome)
Recent (≤1 month) trauma and/or surgery
+2Major trauma or surgery within the past month
Elderly age (≥70 years)
+1Patient is 70 years of age or older
Heart and/or respiratory failure
+1Acute or chronic heart failure or respiratory failure
Acute myocardial infarction or ischemic stroke
+1Recent MI or ischemic stroke
Acute infection and/or rheumatologic disorder
+1Active infection or inflammatory rheumatologic condition
Obesity (BMI ≥30)
+1Body mass index of 30 or higher
Ongoing hormonal treatment
+1Current use of hormonal therapy (e.g., oral contraceptives, hormone replacement therapy)
Clinical Notes:
- • Score 0-3: Low risk (0.3% VTE risk)
- • Score ≥4: High risk (11.0% VTE risk)
- • Specifically validated for hospitalized medical patients
- • Not applicable to surgical patients or outpatients
- • Consider bleeding risk when prescribing thromboprophylaxis
PADUA Prediction Score
The PADUA Prediction Score is a validated risk assessment tool used to identify hospitalized medical patients at risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). This score helps guide thromboprophylaxis decisions in medical inpatients.
Scoring Criteria
The PADUA Score assigns points based on patient characteristics and risk factors:
| Risk Factor | Points |
|---|---|
| Active cancer | +3 |
| Previous VTE (excluding superficial vein thrombosis) | +3 |
| Reduced mobility | +3 |
| Already 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) | +1 |
| Ongoing hormonal treatment | +1 |
Risk Stratification
| Score | Risk Level | VTE Risk |
|---|---|---|
| 0-3 | Low | 0.3% |
| ≥4 | High | 11.0% |
Clinical Application and Management
The PADUA Score helps guide thromboprophylaxis decisions:
- Low Risk (0-3 points):
- VTE risk is 0.3%
- Thromboprophylaxis is generally not recommended
- Early ambulation and adequate hydration are encouraged
- High Risk (≥4 points):
- VTE risk is 11.0%
- Pharmacological thromboprophylaxis is recommended
- Consider LMWH, fondaparinux, or UFH
- Mechanical prophylaxis may be used as adjunct
Important Considerations
The PADUA Score should be used as part of a comprehensive clinical assessment:
- It is specifically validated for medical inpatients
- Not applicable to surgical patients or outpatients
- Should be reassessed if patient condition changes
- Consider bleeding risk when prescribing thromboprophylaxis
- Individual patient factors may influence decision-making
- Follow institutional protocols and guidelines
Validation and Performance
The PADUA Score has been extensively validated:
- Sensitivity: 87.3% for high-risk patients
- Specificity: 66.5% for low-risk patients
- Positive Predictive Value: 11.0%
- Negative Predictive Value: 99.7%
This tool has been widely adopted in clinical practice and is recommended by major guidelines for VTE prevention in medical inpatients.
References
- 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.
- Kahn SR, Lim W, Dunn AS, et al. 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;141(2_suppl):e195S-e226S.
- Spyropoulos AC, Anderson FA Jr, FitzGerald G, et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3):706-714.
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