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Padua Prediction Score for Risk of VTE

Determines anticoagulation need in hospitalized patients by risk of VTE.

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.
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