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    Padua Prediction Score for Risk of VTE

    Determines anticoagulation need in hospitalized patients by risk of VTE.
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    When to Use
    Pearls/Pitfalls
    Why Use

    The Padua score can be applied to hospitalized patients who have the potential risk of VTE. Patients who are high risk (Padua ≥4) could benefit from thromboprophylaxis.

    • 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.
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    Evidence
    Creator Insights

    Advice

    • Many of the patients who developed VTE had active cancer or were older.
    • However, this paper does demonstrate an overall lack of appropriate thromboprophylaxis in patients where the benefit may outweigh the risk.
    • In the appropriate setting when a physician is already considering thromboprophylaxis for a patient considered high risk for VTE, a Padua score of ≥4 has the potential to support their clinical gestalt.

    Management

    For patients admitted to a medical floor:

    • 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.
    Content Contributors
    About the Creator
    Dr. Sofia Barbar
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    Dr. Paolo Prandoni
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