Risk of venous thromboembolism in hospitalized patients (Padua prediction score)
The Padua prediction score determines the risk of developing a venous thromboembolism (VTE) in patients who are hospitalized and have risk factors for developing VTE, therewith identifying patients who might benefit from anticoagulation.
Research authors: Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, and Prandoni P.
Details Formula Study characteristics Files & References
★★★
Model author
Model ID
715
Version
1.35
Revision date
2017-11-17
MeSH terms
  • Thromboembolism
  • Hospitalized Adolescent
  • Model type
    Linear model (Calculation)
    Status
    public
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    Additional information

    Study summary: 
    At total of 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 risk assessment model. Recruited patients were closely supervised during hospitalization and followed-up for up to 90 days after admission. All patients were interviewed by telephone at the end of the 90-day study period in order to ascertain the clinical conditions, the use of antithrombotic drugs, the development of events of interest for the study, and the occurrence of death.

    Study design: 
    Prospective cohort study. 

    Primary study outcome: 
    • Assessment of the risk of VTE complications in high-risk patients who received proper prophylaxis in comparison with those who did not during a 3-month follow-up period.
    Secundaiy study outcomes: 
    • The risk of VTE complications in comparison with low-risk patients.
    • The rate of clinically relevant bleeding in the three study groups.
    Patient population: 
    Patients aged ≥18 years admitted to the Second Division of Internal Medicine of the University of Padua (Italy) between January 2007 and December 2008 were included in the study. 

    Exclusion cirteria: 
    • Current full-dose anticoagulant therapy
    • Indication for anticoagulant therapy for whatever reason
    • Contraindications to pharmacological prophylaxis:
      • Recent or ongoing major bleeding
      • Platelet count <100x10^9/L
    • Creatinine clearance <30 mL/min
    • Pregnancy
    Patients eligible for analysis: 
    Out of 2208 eligible patients, 964 were excluded because of ongoing anticoagulant treatment or medical conditions requiring it, 54 because of contraindications to pharmacological prophylaxis, and 10 for failure to give informed consent. Thus, 1180 patients were recruited for the current investigations, of whom 469 (39.7%) were labelled as having a high risk of VTE (score ≥4) and 711 a low risk (score <4) bas ed on the predefined PADUA score. 

    Source: 
    Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-7.

    Study Population

    Total population size: 1180
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Active cancer Yes 234
    No 946
    Previous VTE Yes 46
    No 1134
    Reduced mobility Yes 272
    No 908
    Thrombophilia Yes 3
    No 1177
    Recent trauma/surgery Yes 31
    No 1149
    Elderly age (≥70 years) Yes 779
    No 401
    Heart and/or respiratory failure Yes 254
    No 926
    Acute myocardial infarction or ischemic stroke Yes 12
    No 1168
    Acute infection or rheumatologic disorder Yes 220
    No 960
    Obesity Yes 76
    No 1104
    Hormonal treatment Yes 13
    No 167

    Padua prediction score:
    ...
    points

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    Padua prediction score: points

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    Outcome stratification

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    Result interpretation

    Context information: 
    The Padua prediction score aims to improve stratification of the thromboembolic risk in hospitalized medical patients compared with usual practise.1 The risk score identifies those medical conditions for which international guidelines strongly recommend thromboprophylaxis.2

    Model restrictions:
    Before being applicable for general application, the Padua prediction score still requires proper confirmation and validation from other large prospective studies. In addition, whether the awareness of the potential value of the Padua prediction score can induce a higher rate of physicians to adopt proper thromboprophylaxis in their patients remains to be demonstrated. 

    Imporant remarks:

    • The Padua prediction 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 using appopriate risk scores. 
    • The Padua prediction risk score was not assessed for patients with contraindications for antithrombotic drugs, because they were excluded from the study. 
    Sources:
    1. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-7.
    2. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(Suppl. 6): 381–453.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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