A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score

Abstract

Summary. Background: Prophylaxis of venous thromboembolism (VTE) in hospitalized medical patients is largely underused. We sought to assess the value of a simple risk assessment model (RAM) for the identification of patients at risk of VTE. Methods: In a prospective cohort study, 1180 consecutive patients admitted to a department of internal medicine in a 2-year period were classified as having a high or low risk of VTE according to a predefined RAM. They were followed-up for up to 90 days to assess the occurrence of symptomatic VTE complications. The primary study outcome was to assess the adjusted hazard ratio (HR) of VTE in high-risk patients who had adequate in-hospital thromboprophylaxis in comparison with those who did not, and that of VTE in the latter group in comparison with low-risk patients. Results: Four hundred and sixty-nine patients (39.7%) were labelled as having a high risk of thrombosis. VTE developed in four of the 186 (2.2%) who received thromboprophylaxis, and in 31 of the 283 (11.0%) who did not (HR of VTE, 0.13; 95% CI, 0.04-0.40). VTE developed also in two of the 711 (0.3%) low-risk patients (HR of VTE in high-risk patients without prophylaxis as compared with lowrisk patients, 32.0; 95% CI, 4.1-251.0). Bleeding occurred in three of the 186 (1.6%) high-risk patients who had thromboprophylaxis. Conclusions: Our RAM can help discriminate between medical patients at high and low risk of VTE. The adoption of adequate thromboprophylaxis in high-risk patients during hospitalization leads to longstanding protection against thromboembolic events with a low risk of bleeding.

Secondary prophylaxis decision‐making in venous thromboembolism: interviews on clinical practice in thirteen countries

“…All four HAS‐BLED users (Brazil, Canada, Poland, the Netherlands) indicated cognizance of the score's original purpose, yet hailed its usefulness and applicability to bleeding risk assessment in VTE, especially in the absence of a dedicated VTE bleeding risk score. Other risk scores that were mentioned by the interviewees were the “Men continue and HER DOO2” clinical decision rule proposed in the REVERSE15 cohort study (Canada), the Padua risk score for VTE (Philippines)16 and the Caprini score for DVT (Philippines) 17…”

Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens

“…After orthopaedic surgery, less aggressive prophylaxis is now considered acceptable 13, 14, 15. In medical patients, LMWH is still recommended according to the Padua Prediction Score; however, large RCTs show elevated risk of haemorrhage and minimal reduction in clinical VTE, calling into question the score's validity and the overall net benefit of liberal LMWH prophylaxis 16, 17, 18…”

Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

“…37 Moreover, in the management of patients with AECOPD we propose a systematic evaluation of thromboembolic risk and of bleeding risk (Appendix Figure 3). For the thromboembolic risk we suggest a score of major reference, the Padua prediction score, that has been proposed and validated in an Italian study 38 and later also adopted by the American College of Chest Physicians (ACCP) guidelines for estimating the risk of venous thromboembolism in hospitalized medical patients 39 For bleeding risk, we propose some warnings, reported in Appendix Figure 3B. Figure 3 summarizes the procedure of oxygen administration.…”