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Padua Prediction Score

VTE risk in hospitalised medical patients — who needs thromboprophylaxis

Sources last checked: 2026-10-13

Padua Prediction Score

VTE risk in hospitalised medical patients — who needs thromboprophylaxis

0
< 4 — low VTE risk

VTE in 0.3 % at 90 days in the derivation cohort. ACCP 2012 recommends against pharmacological prophylaxis in low-risk medical inpatients.

Derived in a single Italian internal-medicine department; external validation is mixed. Bleeding risk (e.g. IMPROVE) is not part of the score. Not validated for surgical patients (surgical models such as Caprini exist).

Source: Barbar S 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.Open

Interpretation

< 4 — low VTE riskVTE in 0.3 % at 90 days in the derivation cohort. ACCP 2012 recommends against pharmacological prophylaxis in low-risk medical inpatients.
≥ 4 — high VTE riskVTE in 11.0 % without and 2.2 % with in-hospital prophylaxis. ACCP 2012 recommends anticoagulant prophylaxis in this group unless bleeding risk is high.

What is the Padua Prediction Score?

The Padua Prediction Score grades VTE risk in acutely ill medical inpatients with eleven weighted risk factors. Barbar and colleagues validated it prospectively in 1,180 consecutive patients at the University of Padua (J Thromb Haemost 2010): high-risk patients (≥ 4) without prophylaxis developed VTE in 11 %, compared with 0.3 % in low-risk patients.

When to use it

  • On admission of an acutely ill medical patient, to decide on pharmacological thromboprophylaxis.
  • Re-assessment when mobility or clinical status changes.
  • Alongside a bleeding score such as IMPROVE.

When not to use it

  • Surgical or trauma patients (use a surgical model).
  • Patients already on therapeutic anticoagulation.
  • Ambulatory cancer patients receiving chemotherapy (use Khorana or Vienna CATS).

How it is calculated

CriterionPoints
Active cancer (local or distant metastases and/or chemo- or radiotherapy in the past 6 months)+3
Previous VTE (excluding superficial vein thrombosis)+3
Reduced mobility (bed rest with bathroom privileges for ≥ 3 days)+3
Known thrombophilic condition+3
Recent (≤ 1 month) trauma and/or surgery+2
Age ≥ 70 years+1
Heart and/or respiratory failure+1
Acute myocardial infarction and/or ischaemic stroke+1
Acute infection and/or rheumatological disorder+1
Obesity (BMI ≥ 30 kg/m²)+1
Ongoing hormonal treatment+1

Clinical pearls and limitations

  • Derived in a single Italian internal-medicine department; external validation is mixed. Bleeding risk (e.g. IMPROVE) is not part of the score. Not validated for surgical patients (surgical models such as Caprini exist).
  • Four items are worth 3 points each: active cancer, previous VTE, reduced mobility, known thrombophilia — one of them plus any 1-point item reaches high risk.
  • Reduced mobility means bed rest (with bathroom privileges) for at least 3 days.
  • With prophylaxis, high-risk patients had 2.2 % VTE (HR 0.13 vs no prophylaxis).
  • The ACCP 2012 guideline used Padua ≥ 4 to define increased risk in medical inpatients.

Frequently asked questions

What Padua score needs thromboprophylaxis?

A score of 4 or more defines high VTE risk; for this group ACCP 2012 recommends anticoagulant prophylaxis unless bleeding risk is high.

Is the Padua score for surgical patients?

No, it was developed for hospitalised medical patients. Surgical patients need a surgical risk model.

What counts as a thrombophilic condition?

Known inherited or acquired thrombophilia: antithrombin, protein C or S deficiency, factor V Leiden, prothrombin G20210A, or antiphospholipid syndrome.

Evidence and guidelines

  1. Primary source: Barbar S 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.
  2. Kahn SR et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed (ACCP). Chest 2012;141(2 Suppl):e195S-e226S — Table with Padua score, high risk ≥ 4.

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