Assess every medical inpatient for VTE risk on admission, reassess at 24 h or on any change. Weigh thrombosis vs bleeding risk, then choose pharmacological, mechanical, or both.
Risk score: Padua (medical inpatients)
| Risk factor | Points |
|---|---|
| Active cancer | 3 |
| Previous VTE (excluding superficial) | 3 |
| Reduced mobility (bedrest ≥ 3 days) | 3 |
| Known thrombophilia | 3 |
| Recent (≤ 1 month) trauma or surgery | 2 |
| Age ≥ 70 | 1 |
| Heart and/or respiratory failure | 1 |
| Acute MI or ischaemic stroke | 1 |
| Acute infection or rheumatological disorder | 1 |
| BMI ≥ 30 | 1 |
| Ongoing hormonal treatment | 1 |
Score ≥ 4 = high risk → pharmacological prophylaxis if no bleeding contraindication · Padua score · MDCalc ↗︎
When to avoid pharmacological prophylaxis (bleeding risk)
| Contraindication / caution |
|---|
| Active bleeding |
| Platelets < 50 |
| Acute haemorrhagic stroke |
| Severe uncontrolled hypertension |
| Known bleeding disorder or on therapeutic anticoagulation |
| Recent neurosurgery / spinal surgery, or LP within 4 h |
If pharmacological prophylaxis is contraindicated, use mechanical prophylaxis and reassess daily.
Options
| Type | Agent / device | Dose / use |
|---|---|---|
| LMWH | Enoxaparin (Clexane) | 40 mg SC OD; weight < 50 kg or BMI > 40 → adjust per local policy |
| UFH, if CrCl < 30 | Heparin | 5,000 units SC q8–12h (or enoxaparin 20 mg SC OD per local policy) |
| Mechanical | Pneumatic compression (IPC) or anti-embolism stockings | When anticoagulation is contraindicated; no stockings in significant PAD |
Educational reference for clinicians. Padua thresholds, prophylaxis choices, contraindications, and renal function must be checked against current local policy before use.
Last updated · October 2026