From the Guidelines
Patients with a Padua score of 4 or higher should receive pharmacological thromboprophylaxis to prevent deep vein thrombosis (DVT) unless contraindicated, as the reduction in VTE appears to outweigh the increased risk of bleeding with pharmacologic prophylaxis 1.
Padua Score Risk Stratification
The Padua Prediction Score is a validated tool for assessing the risk of venous thromboembolism (VTE) in hospitalized medical patients. The score evaluates 11 risk factors, including:
- Active cancer (3 points)
- Previous VTE (3 points)
- Reduced mobility (3 points)
- Known thrombophilic condition (3 points)
- Recent trauma/surgery within the past month (2 points)
- Age ≥70 years (1 point)
- Heart/respiratory failure (1 point)
- Acute myocardial infarction or ischemic stroke (1 point)
- Acute infection and/or rheumatologic disorder (1 point)
- BMI ≥30 kg/m² (1 point)
- Ongoing hormonal treatment (1 point)
Risk Stratification and Prophylaxis
Patients with a score of 4 or higher are considered high-risk and should receive pharmacological thromboprophylaxis unless contraindicated. For high-risk patients, standard prophylaxis includes low molecular weight heparin (such as enoxaparin 40mg subcutaneously once daily), unfractionated heparin (5000 units subcutaneously every 8-12 hours), or fondaparinux (2.5mg subcutaneously once daily) 1. Prophylaxis should typically continue throughout hospitalization.
Balancing Thrombosis and Bleeding Risk
The Padua score helps clinicians balance the risk of thrombosis against bleeding risk, ensuring that preventive anticoagulation is provided to those who would benefit most while avoiding unnecessary treatment in low-risk patients. According to the study, the incidence of VTE without prophylaxis is 11% in patients with a Padua score ≥ 4, compared to 2.2% with prophylaxis 1.
From the Research
Padua Score Risk Stratification for DVT Occurrence in Admitted Patients
- The Padua score is a tool used to predict the risk of venous thromboembolism (VTE) in hospitalized patients 2.
- However, the provided studies do not directly address the Padua score risk stratification for DVT occurrence in admitted patients.
- The studies focus on various methods of VTE prophylaxis, including intermittent pneumatic compression (IPC), graduated compression stockings (GCS), low-molecular-weight heparin (LMWH), and unfractionated heparin (UFH) 3, 4, 5, 6.
- These studies suggest that different prophylactic methods have varying degrees of effectiveness in preventing VTE, but they do not provide information on the Padua score specifically.
VTE Prophylaxis Methods
- IPC devices have been shown to be effective in decreasing the incidence of DVT in patients at moderate to high risk 6.
- The combination of IPC and GCS may be more efficacious than GCS alone for high-risk patients 5.
- LMWH has been found to be superior to UFH in reducing the incidence of mortality and VTE events among trauma patients 3.
- Enoxaparin and UFH have been shown to be efficient and safe for the prophylaxis of DVT in patients undergoing lower extremity amputation 4.
Limitations
- The provided studies do not directly address the Padua score risk stratification for DVT occurrence in admitted patients.
- Further research is needed to determine the effectiveness of different VTE prophylaxis methods in relation to the Padua score.