Geneva Risk Score for Venous Thromboembolism (VTE) Prophylaxis

Geneva VTE Calculator

Active Cancer

Prior VTE

Recent Surgery (≤1 month)

Age >60 years

Heart Failure

Acute Infection

BMI ≥30 kg/m²

Acute MI or Ischemic Stroke

Acute Respiratory Failure

Geneva VTE Score: –

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Predicts need for VTE prophylaxis in admitted patients.

Why Use

Prophylaxis rates vary widely across institutions; in one study, 29%–89% of inpatients received VTE prophylaxis ( Chopard et al., 2006 ). This tool helps identify low-risk patients who may not need routine pharmacologic prophylaxis, supporting more consistent, evidence-based use of resources.

When to Use

Use on admission (and with major clinical changes) in acutely ill adult medical inpatients to stratify in-hospital VTE risk and guide prophylaxis decisions.

Formula

Addition of the selected points: Variable Points Cardiac failure 2 Respiratory failure 2 Recent stroke (<3 months ago) 2 Recent myocardial infarction (<4 weeks ago) 2 Acute infectious disease (including sepsis) 2 Acute rheumatic disease 2 Active malignancy 2 Myeloproliferative syndrome 2 Nephrotic syndrome 2 History of venous thromboembolism 2 Known hypercoagulable state 2 Immobilization (<30 min walking per day) for ≥3 days 1 Recent travel for >6 hrs 1 Age >60 years 1 BMI >30 kg/m² 1 Chronic venous insufficiency 1 Pregnancy 1 Hormonal therapy (contraceptive or replacement therapy) 1 Dehydration 1

Pearls / Pitfalls

Separates patients into low vs high risk for the composite of 90-day symptomatic VTE or VTE-related death. Not intended for outpatients or surgical/obstetric/trauma pathways.

Management

Low risk (score <3): Routine pharmacologic thromboprophylaxis is generally not indicated. Prioritize early mobilization and reassess if status changes. High risk (score ≥3): Initiate pharmacologic prophylaxis per local protocol (e.g., LMWH/UFH) after bleeding-risk assessment. Emphasize early mobilization and use mechanical methods when pharmacologic agents are contraindicated or insufficient.

Critical Actions

Always weigh bleeding risk before prescribing anticoagulant prophylaxis; consider a formal tool, such as the IMPROVE Bleeding Risk Score .

Advice

Use the score to complement, not replace, clinical judgment when making therapeutic decisions. Risk factors for VTE (especially mobility status) can evolve during hospitalization; reassess periodically.

More Information

Interpretation: Geneva Score for VTE Prophylaxis Risk Group Risk of VTE* Recommendation <3 Low 0.6% No VTE prophylaxis indicated ≥3 High 3.2% VTE prophylaxis indicated *Composite endpoint of symptomatic VTE or VTE-related death at 90 days. From Nendaz 2014 .