Padua VTE Prediction Score
The Padua Prediction Score stratifies acutely ill medical inpatients by VTE risk to guide thromboprophylaxis decisions. A score ≥4 identifies high-risk patients who should receive pharmacologic prophylaxis.
inputs
✓ when to use
Use for all acutely ill medical inpatients to determine whether pharmacologic VTE prophylaxis is indicated. Complement with IMPROVE Bleeding Risk Score to assess the bleeding risk of prophylaxis. Applicable in medical wards, acute medicine, and hospital-at-home settings.
✗ when not to use
The Padua score is for medical inpatients, not surgical patients (use Caprini for surgical VTE risk). Not validated in ambulatory outpatients or obstetric patients. Does not assess bleeding risk — always pair with a bleeding risk assessment (IMPROVE) before starting prophylaxis.
clinical pearls
- The highest-weighted items are active cancer (3), previous VTE (3), reduced mobility (3), and thrombophilia (3). Any one of these combined with one 1-point factor reaches the ≥4 threshold.
- Reduced mobility is defined as anticipated bed rest with bathroom privileges for ≥3 days. This is the most commonly scored item and applies to many medical admissions.
- Always assess bleeding risk before starting thromboprophylaxis. The IMPROVE Bleeding Risk Score helps identify patients where the bleeding risk of prophylaxis may outweigh the VTE prevention benefit.
- Pharmacologic prophylaxis is typically LMWH (enoxaparin 40mg SC daily in the UK) or fondaparinux. DOACs are not routinely used for medical inpatient prophylaxis (unlike surgical prophylaxis).
- Mechanical prophylaxis (anti-embolism stockings, IPC devices) is an alternative when pharmacologic prophylaxis is contraindicated (active bleeding, severe thrombocytopenia, high bleeding risk).