Padua Prediction Score Calculator

Add the 11 Padua risk factors to estimate venous thromboembolism risk in hospitalized medical patients.

What it does

The Padua Prediction Score estimates the risk of venous thromboembolism in adults admitted to a medical service. It was developed because surgical risk models did not fit medical patients well. The score is short enough to complete at admission and specific enough to separate patients who benefit from prophylaxis from those who do not.

Eleven factors are weighted. Active cancer, previous venous thromboembolism, reduced mobility, and known thrombophilia each add 3 points. Recent trauma or surgery adds 2. Age 70 or older, heart or respiratory failure, acute myocardial infarction or ischemic stroke, acute infection or rheumatologic disorder, obesity, and hormonal treatment each add 1 point.

A total of 4 or more is high risk. In the original validation, high risk patients had a much higher rate of venous thromboembolism without prophylaxis, and prophylaxis reduced that rate. Low risk patients had a low event rate, so the benefit of anticoagulation was less clear. The cutoff is simple, but the decision still depends on bleeding risk and the reason for admission.

The score is meant for medical inpatients, not for routine outpatient visits and not for surgical patients. It is also not a tool for pregnancy, which has its own risk assessment. Some hospitals use Padua for all medical admissions, while others reserve it for patients with limited mobility. The model works best when the same definitions are used every time.

Several items overlap with other conditions. A patient with cancer and reduced mobility can score 6 before any laboratory result is available. That is intentional: the score is a bedside estimate, not a claim of certainty. Document which factors were counted and review the plan if the patient develops a new infection, a new immobility, or a bleeding complication.

How to use

1. Confirm that the patient is a medical inpatient. Padua was not designed for surgical or obstetric risk assessment.
2. Check for active cancer, previous venous thromboembolism, reduced mobility, and known thrombophilia. Each is worth 3 points.
3. Check for recent trauma or surgery within the last month. This is worth 2 points.
4. Work through the one point factors: age 70 or older, heart or respiratory failure, acute myocardial infarction or ischemic stroke, acute infection or rheumatologic disorder, obesity, and hormonal treatment.
5. Add the points. A total of 4 or more is high risk; 3 or less is low risk.
6. Compare the band with the local prophylaxis protocol, review bleeding risk, and document the plan.

Formula

3 point factors

Active cancer, previous venous thromboembolism, reduced mobility, known thrombophilia.

2 point factor

Recent trauma or surgery within the last month.

1 point factors

Age 70 or older, heart or respiratory failure, acute myocardial infarction or ischemic stroke, acute infection or rheumatologic disorder, obesity, hormonal treatment.

Total

Sum from 0 to 20. A value of 4 or more is high risk.

Reduced mobility means bed rest for at least 3 days or walking only with the help of another person. Active cancer means cancer diagnosed in the last 6 months or cancer that is being treated now. Obesity uses a BMI of 30 or higher, which is different from the Caprini cutoff of 25. The score does not include a D-dimer, imaging result, or platelet count. It should be completed before prophylaxis is started, not after.

Worked example

Reference table

Limits

• The score was designed for medical inpatients. It does not apply directly to surgical, obstetric, or pediatric patients.
• It estimates risk but does not measure bleeding risk, so it cannot decide prophylaxis by itself.
• Some factors, such as reduced mobility and active cancer, depend on how the clinician applies the definitions.
• The score does not include recent central venous access or inherited thrombophilia details beyond a single yes or no.

Common mistakes

• Using a BMI of 25 for the obesity item. Padua uses BMI 30 or higher.
• Counting active cancer and recent surgery as the same factor.
• Marking reduced mobility when the patient walks independently, even if slowly.
• Applying the score to a surgical patient instead of a medical admission.
• Starting prophylaxis from the score alone without checking platelet count, kidney function, or active bleeding.

Try it yourself

Quick checks. Answers sit tucked under each question.

Questions

Sources

• AHRQ: venous thromboembolism risk assessment models, including Padua
• External validation of the Padua and IMPROVE-VTE risk models

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