Padua Prediction Score for Risk of VTE

Why Use

All hospitalized patients are at increased risk for VTE. High risk patients for VTE are often not adequately prophylaxed. VTE is associated with increased morbidity and mortality.

When to Use

The Padua score can be applied to hospitalized patients who have the potential risk of VTE. Patients who are high risk (Padua ≥4) could benefit from thromboprophylaxis.

Formula

Pearls / Pitfalls

The Padua prediction score identifies admitted patients who may be high risk for venous thromboembolism (VTE) and would benefit from thromboprophylaxis. Though promising, the Padua score has yet to be validated in large prospective studies and therefore its routine use can not be completely supported. A retrospective review of patients with sepsis found no relationship between a Padua ≥4 and VTE, though it was a predictor of mortality. The model was based off of a previously published clinical prediction rule and not derived from formal criteria. The majority of patients who developed VTE had active cancer. Follow-up VTE testing was only performed if the patient was symptomatic. Patients with contraindications to prophylaxis were not included in the study.

Management

For patients admitted to a medical floor: Padua Score <4: Low risk of VTE. Thromboprophylaxis should be considered on a case-by-case basis. Padua Score ≥4: High risk of VTE. Thromboprophylaxis (i.e. heparin / enoxaparin) is recommended for non-pregnant patients without contraindications (major bleeding, low platelets, creatinine clearance <30 mL/min) who are >18 years.

Critical Actions

The Padua score is meant to risk stratify patients who have a potential risk for VTE, not to diagnose VTE. If deemed appropriate, anticoagulation should not be withheld from patients who require it as part of the treatment for their diagnosis. Prior to initiating any anticoagulant therapy a patient’s bleeding risk should be evaluated.

Advice

Many of the patients who developed VTE had active cancer or were older. However, this paper does demonstrate an overall lack of appropriate thromboprophylaxis in patients where the benefit may outweigh the risk. In the appropriate setting when a physician is already considering thromboprophylaxis for a patient considered high risk for VTE, a Padua score of ≥4 has the potential to support their clinical gestalt.

More Information

Score interpretation: Padua Score ≥4 points - Pharmacologic prophylaxis is indicated. If high risk of bleeding, use mechanical prophylaxis. Padua Score <4 points - Pharmacologic prophylaxis is not indicated, consider using mechanical prophylaxis.