Padua Prediction Score (VTE Risk Calculator)

The Padua Prediction Score (Barbar S et al., J Thromb Haemost 2010) assesses the risk of venous thromboembolism (VTE) in hospitalized non-surgical patients. It includes 11 weighted parameters: active cancer (3), previous VTE (3), immobilization ≥ 3 days (3), known thrombophilia (3), trauma/surgery within the past month (2), age ≥ 70 years (1), heart/respiratory failure (1), acute myocardial infarction or ischemic stroke (1), acute infection/rheumatologic disease (1), BMI ≥ 30 (1), hormonal therapy (1).

Interpretation: a score ≥ 4 points indicates high VTE risk, and pharmacologic prophylaxis is recommended (low-molecular-weight heparin, fondaparinux, or mechanical compression if contraindicated). A score < 4 indicates low risk, and pharmacologic prophylaxis is generally not indicated.

The score is recommended by the ACCP 9th Edition (2012) and the ESC 2019 Guidelines on Acute Pulmonary Embolism as the standard risk stratification tool for non-surgical inpatients. An alternative is the IMPROVE Score, which also accounts for bleeding risk.

• Admission to a non-surgical department (internal medicine, cardiology, neurology, infectious disease).
• Deciding whether to initiate pharmacologic VTE prophylaxis.
• Dynamic reassessment when the patient's status changes.
• Documenting the rationale for prophylaxis or its omission for insurance purposes.

• Does not account for bleeding risk; a parallel score is needed (IMPROVE Bleeding Risk).
• Not validated for surgical patients; the Caprini Score applies there.
• The age threshold of 70 years is coarse; patients aged 65-69 with comorbidities may have higher risk that the score does not capture.
• Immobility is a subjective criterion and requires documentation.