What the Padua score predicts
Adults admitted to hospital for a medical illness, such as pneumonia, heart failure or a flare of a chronic disease, spend long periods in bed and are at risk of venous thromboembolism: a deep vein thrombosis in the leg or a pulmonary embolism. The Padua prediction score, published by Barbar and colleagues in 2010, sorts these patients into low and high risk to guide preventive treatment.
The 11 risk factors
| Factor | Points |
|---|---|
| Active cancer (metastases, or chemo- or radiotherapy in the past 6 months) | 3 |
| Previous venous thromboembolism | 3 |
| Reduced mobility (bed rest for at least 3 days) | 3 |
| Known thrombophilia | 3 |
| Trauma or surgery in the past month | 2 |
| Age 70 or older | 1 |
| Heart or respiratory failure | 1 |
| Acute heart attack or ischemic stroke | 1 |
| Acute infection or rheumatologic disorder | 1 |
| Obesity (BMI 30 or more) | 1 |
| Ongoing hormonal treatment | 1 |
Interpreting the total
- Below 4: low risk. In the original study, about 0.3% of these patients had a clot within 90 days without prevention.
- 4 or more: high risk. About 11% of high-risk patients who did not receive prevention developed a clot, compared with about 2% of those who did.
Worked example
A patient admitted with heart failure (1 point) who is expected to stay mostly in bed for several days (3 points) scores 4, which is high risk. Unless the bleeding risk is high, preventive anticoagulation would usually be considered.
How it is used
Guidelines such as those from the American College of Chest Physicians and the American Society of Hematology suggest assessing every medical inpatient for clot risk. For high-risk patients, prevention usually means a low dose of low-molecular-weight heparin, unfractionated heparin or fondaparinux. When bleeding risk is high, mechanical options such as intermittent pneumatic compression are used instead.
The decision always weighs clot risk against bleeding risk. Factors such as active bleeding, a low platelet count, recent bleeding or severe kidney or liver disease can tip the balance toward mechanical prevention.
Limits
The Padua score was developed in a single Italian center and has been validated with mixed results elsewhere. It does not apply to surgical patients, who are usually assessed with the Caprini score, nor to pregnant women or children. Other tools, such as the IMPROVE score, are also used for medical inpatients.
This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.