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Padua Prediction Score Calculator (VTE in Medical Patients)

Venous thromboembolism risk for hospitalised medical patients with the Padua Prediction Score — active cancer, prior VTE, reduced mobility, thrombophilia, trauma, age, heart or respiratory failure, MI or stroke, infection, obesity, hormones.

Active cancer — metastases and/or chemo or radiotherapy in the last 6 months (3)

Previous VTE, excluding superficial thrombophlebitis (3)

Reduced mobility — bed rest with bathroom privileges ≥ 3 days (3)

Known thrombophilic condition (3)

Recent trauma and/or surgery ≤ 1 month (2)

Age ≥ 70 (1)

Heart and/or respiratory failure (1)

Acute MI or ischaemic stroke (1)

Acute infection and/or rheumatological disorder (1)

Obesity, BMI ≥ 30 (1)

Ongoing hormonal treatment (1)

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How it works

Active cancer 3 + prior VTE 3 + reduced mobility 3 + thrombophilia 3 + trauma/surgery 2 + age ≥ 70 1 + heart/respiratory failure 1 + MI/stroke 1 + infection/rheumatological 1 + obesity 1 + hormones 1; ≥ 4 = high risk

Medical inpatients — those admitted with pneumonia, heart failure, sepsis or stroke rather than for surgery — account for most hospital-acquired venous thromboembolism, yet many are over- or under-treated. The Padua Prediction Score, derived in Italy and endorsed by the ACCP guidelines, splits them cleanly: below 4 the VTE rate is well under 1% and anticoagulant prophylaxis offers little; at 4 or more the rate approaches 11% and prophylaxis cuts it roughly fivefold. The four heaviest items — active cancer, prior VTE, immobility and thrombophilia — each score three, so any one of them plus a single minor factor reaches the threshold. Pair it with a bleeding-risk assessment (IMPROVE) before prescribing.

Worked example

A 74-year-old admitted with pneumonia and confined to bed for four days: mobility 3 + age 1 + infection 1 = 5 — high risk, LMWH prophylaxis.

Frequently asked questions

What about the IMPROVE score?

IMPROVE VTE is an alternative with seven items; IMPROVE Bleed assesses bleeding risk. Many hospitals pair Padua (or IMPROVE VTE) with IMPROVE Bleed.

Does prophylaxis continue after discharge?

Routine extended prophylaxis is not recommended for medical patients; trials of extended DOAC prophylaxis showed modest benefit offset by bleeding, so it is reserved for selected high-risk patients.

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Calculate a weight-based unfractionated heparin bolus and starting infusion in units, mL and mL/hour (VTE nomogram 80 units/kg + 18 units/kg/h, ACS 60 units/kg + 12 units/kg/h with maximums, or your protocol's doses and caps), then convert an aPTT result into the nomogram rate change.

Clinical decision tool for education and for use by trained clinicians alongside judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.