Determines anticoagulation need in hospitalized patients by risk of VTE.

  • 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 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.
  • 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.
For patients admitted to a medical department:
  • 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.
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