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Printed on 7/19/2026
For informational purposes only. This is not medical advice.
The Padua Prediction Score stratifies VTE risk in acutely ill hospitalized medical patients. A total score of 4 or more indicates high risk (approximately 11% VTE risk at 90 days) and supports pharmacologic thromboprophylaxis when bleeding risk is acceptable. The score evaluates 11 weighted clinical risk factors including active cancer, prior VTE, reduced mobility, and thrombophilia. Unlike CAPRINI, which is designed for surgical patients, Padua was specifically validated for medical inpatients. Always pair with a bleeding risk assessment (IMPROVE Bleeding Score or ACCP criteria) before prescribing prophylaxis. [LMWH](/tools/vancomycin-dosing) is preferred over unfractionated heparin in most medical patients.
Formula: Padua score = sum of weighted risk factors. High VTE risk if total ≥4.
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The Padua score evaluates 11 clinical variables, each weighted by VTE contribution. Highest-weight items (3 points each): active cancer (local or distant, receiving treatment or diagnosed within 6 months), prior VTE (excluding superficial vein thrombosis), reduced mobility (anticipated bedrest for ≥3 days due to patient limitation or physician order), and known thrombophilia (antithrombin deficiency, protein C/S deficiency, Factor V Leiden, antiphospholipid syndrome, prothrombin gene mutation). Medium-weight items (2 points): recent trauma or surgery within the past month. Low-weight items (1 point each): age ≥70 years, heart failure or respiratory failure, acute MI or ischemic stroke, acute infection or rheumatologic disorder, obesity (BMI >30 kg/m²), and ongoing hormonal treatment (oral contraceptives, hormone replacement therapy, gonadotropin-releasing hormone agonists). Score each factor systematically at the time of hospital admission and document the total.
Sum all applicable risk factors to obtain a total Padua score between 0 and 20. Risk stratification: Score <4 (low risk) — approximately 0.3% VTE incidence at 90 days without prophylaxis. These patients do not require pharmacological VTE prophylaxis, though early mobilization and hydration are still encouraged. Score ≥4 (high risk) — approximately 11% VTE incidence at 90 days without prophylaxis, a roughly 35-fold higher risk compared to low-risk patients. High-risk patients are candidates for pharmacological thromboprophylaxis if bleeding risk is acceptable. The most commonly prescribed agents are LMWH (enoxaparin, dalteparin) or fondaparinux. Unfractionated heparin (UFH) is an alternative but is less preferred due to frequent dosing requirements and heparin-induced thrombocytopenia risk. Document the Padua score and risk category in the admission note.
A high Padua score alone does not automatically mean prophylaxis should be prescribed — bleeding risk must be assessed concurrently. Use the IMPROVE Bleeding Risk Score or ACCP bleeding criteria to identify contraindications. Major bleeding risk factors: active bleeding, severe thrombocytopenia (platelets <50k), liver failure (INR >1.5 from hepatic cause), renal failure (CrCl <30 mL/min — requires dose adjustment for LMWH), recent neurosurgery, spinal cord injury, or intracranial hemorrhage. If pharmacological prophylaxis is contraindicated due to bleeding risk, prescribe mechanical prophylaxis: graduated compression stockings (GCS) and/or intermittent pneumatic compression (IPC) devices. Reassess VTE and bleeding risk at each care transition (e.g., transfer to ICU, new bleeding event, change in clinical status). Prophylaxis should begin at hospital admission and continue for the duration of hospitalization. Extended prophylaxis after discharge is generally not recommended for most medical inpatients (the EXCLAIM and MAGELLAN trials showed modest benefit with increased bleeding risk), except in select high-risk patients such as cancer patients, for whom extended prophylaxis may be considered.
Hospitalists and internal medicine physicians
Apply the Padua score at hospital admission for every acutely ill medical inpatient to determine VTE prophylaxis need. Score ≥4 supports LMWH or fondaparinux prophylaxis; score <4 indicates low risk where early mobilization suffices. Document the score in the admission note alongside a bleeding risk assessment, creating an auditable, evidence-based thromboprophylaxis decision. Reassess if the clinical status changes substantially during the hospital stay.
Rheumatologists and rheumatology nurses
Patients admitted for rheumatologic flares (lupus, vasculitis, inflammatory arthritis) often have reduced mobility, active inflammatory disease, and concurrent corticosteroid or hormonal therapy — all Padua risk factors. Use the Padua score to guide prophylaxis decisions in these patients, noting that systemic inflammation itself contributes to VTE risk beyond the scored factors. Coordinate with pharmacy for LMWH dosing in patients with renal impairment, which is common in lupus nephritis.
Oncologists and oncology nurses
Cancer patients have a 4–7 times higher VTE risk than non-cancer patients and frequently score ≥4 on Padua due to active cancer (3 points) plus reduced mobility or other co-factors. Use the Padua score to systematically identify high-risk oncology inpatients who need pharmacological prophylaxis. For cancer patients receiving chemotherapy in the outpatient setting, the Khorana Score is more appropriate — Padua is for inpatients. Consider extended prophylaxis after discharge for selected high-risk cancer inpatients per ARIXTRA trial data.
Admitting teams, triage nurses, and clinical pharmacists
Incorporate Padua scoring into the standardized admission workflow for all medical inpatients. EHR-integrated clinical decision support tools that auto-calculate Padua at admission can prompt clinicians to document prophylaxis decisions, reducing omission of indicated thromboprophylaxis. Many hospitals have achieved Joint Commission VTE prevention standards by embedding Padua or equivalent risk tools into order sets, with automatic prophylaxis prompts for high-risk patients. Use the score in pharmacist-led anticoagulation reviews to ensure high-risk patients without documented prophylaxis receive review.
Long-term care physicians and nursing home staff
Patients transferred from the hospital to skilled nursing facilities (SNF) or nursing homes may still have elevated Padua scores due to reduced mobility, ongoing cancer treatment, or recent surgery. The Padua score can be applied at SNF admission to determine if VTE prophylaxis should continue beyond the inpatient stay, particularly for patients who scored high at hospital admission and still have significant risk factors at the time of transfer.
Hospital quality improvement teams and infection control committees
Use Padua scoring data to audit VTE prevention rates across medical wards. Track the percentage of high-risk patients (Padua ≥4) who received appropriate prophylaxis and identify gaps in prophylaxis delivery. Compare VTE event rates before and after implementing standardized Padua-based pathways. Report prophylaxis rates as a quality metric to hospital administration and accreditation bodies. Padua-based VTE prevention programs have been associated with significant reductions in hospital-acquired DVT and PE in prospective implementation studies.
This is the most common misapplication of the Padua score. Padua was derived and validated exclusively in acutely ill hospitalized medical patients (internal medicine, cardiology, pulmonology, rheumatology). For surgical patients — including general surgery, orthopedic surgery, gynecology, and urology — use the CAPRINI score, which was specifically designed for the peri-operative population. Applying Padua to surgical patients may under-estimate VTE risk, since Padua does not account for surgery type, duration, or procedural VTE risk. The distinction matters: hospitalized medical patients have a baseline VTE risk of ~0.3–1%, while high-risk surgical patients (e.g., total hip arthroplasty) have rates of 3–20% without prophylaxis.
A Padua score ≥4 identifies high VTE risk but does not mean pharmacological prophylaxis is always appropriate. You must assess bleeding risk using validated criteria (IMPROVE Bleeding Score or ACCP bleeding criteria) before prescribing LMWH or fondaparinux. Major contraindications include active bleeding, platelet count <50k, severe renal failure (CrCl <15–30 mL/min — dose-adjust LMWH or use UFH), recent intracranial surgery or hemorrhage, and uncontrolled hypertension. If bleeding risk is high, switch to mechanical prophylaxis (intermittent pneumatic compression devices, graduated compression stockings) and reassess daily for the window when pharmacological prophylaxis becomes safe.
Evidence from the MEDENOX trial (enoxaparin 40 mg daily vs placebo) and subsequent studies supports LMWH as the preferred pharmacological prophylaxis agent for high-risk medical inpatients. Advantages over UFH: once-daily dosing (vs BID or TID for UFH), lower risk of heparin-induced thrombocytopenia (HIT), no requirement for aPTT monitoring, and at least equivalent or superior efficacy. UFH 5,000 units TID remains an acceptable alternative when LMWH is cost-restricted or when renal insufficiency makes LMWH accumulation a concern (CrCl 15–30 mL/min — consider anti-Xa monitoring or switch to UFH). Fondaparinux (2.5 mg daily SC) is an alternative in patients with HIT history or heparin allergy.
VTE risk begins at hospital admission — delaying prophylaxis by even 24 hours increases DVT risk in high-Padua patients. Start LMWH on the first hospital day in patients with Padua ≥4 unless contraindicated. Reassess the Padua score and bleeding risk with each significant change in clinical status: new bleeding event (reduces prophylaxis candidates), clinical deterioration requiring ICU transfer (may increase or decrease mobility score), surgery performed during admission (switch to CAPRINI-based peri-operative pathway), or new diagnosis of cancer or thrombophilia (increases Padua score). Document reassessments in daily progress notes.
Active cancer alone scores 3 points on the Padua score, placing most cancer inpatients just one point below the high-risk threshold. Any single additional risk factor (age ≥70, acute infection, reduced mobility) will cross into high-risk territory. This reflects the biological reality that cancer is a profoundly prothrombotic state: tumor cells express tissue factor, activate platelets, and cause systemic coagulation activation. The ARIXTRA trial showed that extended fondaparinux prophylaxis after discharge reduced VTE in high-risk medical patients, though this benefit was concentrated in cancer patients. Discuss post-discharge prophylaxis with your oncology team for appropriate cancer inpatients.
Reduced mobility scores 3 points — the same as active cancer — and it is the most modifiable risk factor in the Padua score. If a patient's bedrest is due to pain, deconditioning, or physician-ordered restriction rather than a medical necessity, early mobilization should be aggressively pursued as a non-pharmacological VTE prevention strategy. Physical therapy consultation, pain management optimization, and nursing-driven mobility protocols can reduce the duration of reduced mobility. Patients who regain independent mobility during hospitalization may no longer meet the 3-point criterion, potentially reducing their overall Padua score below 4.
Unlike surgical patients (especially after total hip/knee arthroplasty, where extended prophylaxis for 28–35 days post-op is standard), most medical inpatients do NOT benefit from extended VTE prophylaxis after hospital discharge. The EXCLAIM trial showed modest benefit of extended enoxaparin prophylaxis but with significant increase in major bleeding. The MAGELLAN trial (rivaroxaban extended prophylaxis) also showed increased bleeding without net clinical benefit in unselected medical patients. Extended prophylaxis may be appropriate in select high-risk groups: cancer patients with high VTE risk and acceptable bleeding risk, patients with known thrombophilia, or those with prolonged immobility (e.g., stroke patients). Follow local guidelines and discuss risk-benefit with patients.
The thrombophilia criterion (3 points) should only be scored if the patient has a documented, laboratory-confirmed thrombophilic condition: antithrombin III deficiency, protein C or S deficiency, Factor V Leiden (heterozygous or homozygous), prothrombin gene mutation (G20210A), antiphospholipid syndrome (two positive lab tests ≥12 weeks apart), or hyperhomocysteinemia. Suspicion of thrombophilia without laboratory confirmation does not count. Note that thrombophilia testing during acute illness can be misleading: protein C and S levels fall during acute thrombosis and with warfarin use, antithrombin drops during acute thrombosis and with heparin use. If thrombophilia testing is needed, defer to outpatient workup ≥3 months after the acute event.
When a high-Padua patient has a temporary bleeding contraindication (e.g., post-procedure, awaiting platelet transfusion, active GI bleed being managed), apply intermittent pneumatic compression (IPC) devices as a bridge to pharmacological prophylaxis. IPC devices work by reducing venous stasis and enhancing fibrinolytic activity. They are most effective when worn for ≥18 hours per day and should be applied bilaterally to both legs (unless lower extremity pathology, such as skin breakdown, DVT, or peripheral arterial disease with ABI <0.6, contraindicates use). Graduated compression stockings (GCS) are a less effective alternative and are not recommended as the sole mechanical prophylaxis agent in high-risk patients. Reassess daily for the opportunity to initiate pharmacological prophylaxis once bleeding risk decreases.
A critical distinction: the Wells DVT and Wells PE scores are diagnostic tools used when a patient presents with SYMPTOMS suggesting active VTE (unilateral leg swelling, pleuritic chest pain, dyspnea). They estimate the probability of an existing clot that needs to be diagnosed and treated. The Padua score, by contrast, is a PREVENTION tool used in asymptomatic patients to identify who needs prophylaxis to prevent a future VTE event. Do not confuse these roles. If a patient with a high Padua score develops leg swelling or dyspnea, switch to the Wells DVT or Wells PE scoring framework for diagnostic workup. Both frameworks are often used in the same patient at different clinical decision points.
Padua prediction score was developed by Barbar et al. (J Thromb Haemost 2010) and prospectively validated in hospitalized medical patients. Score ≥4 carried 11.0% VTE risk vs 0.3% for score <4 at 90 days. ACCP 2012 Guidelines and ISTH recommend pharmacological prophylaxis for high-risk Padua patients without bleeding contraindications. The Padua score is endorsed by the American Society of Hematology (ASH) 2018 Guidelines.
A higher Padua score indicates greater inpatient VTE risk; scores ≥4 generally support thromboprophylaxis discussions when bleeding risk is acceptable. Low scores (<4) indicate approximately 0.3% VTE risk — early mobilization and hydration are encouraged but pharmacological prophylaxis is not required.
Use this score during admission and daily medical-inpatient reassessment to guide VTE prevention strategy. Apply to all acutely ill hospitalized medical patients. Always pair with a bleeding risk assessment before prescribing pharmacological prophylaxis.
Padua is a risk-stratification aid for medical inpatients only (not surgical patients) and should be applied with clinical judgment, bleeding-risk assessment, and local prophylaxis protocols. It does not account for all thrombophilic states, and some risk factors (obesity, hormonal therapy) contribute only 1 point despite clinically meaningful VTE contribution.
For related assessments, see Caprini Score, Wells Score (DVT) and 4T Score (HIT).
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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