Padua prediction score and thrombin generation in hospitalized medical patients

The Padua prediction score is a risk assessment model used to identify medical patients at high risk for venous thromboembolim (VTE).We aimed to assess the relationship between the severity of Padua score and thrombin generation as a measure of overall thrombotic activity.

A total of 253 patients hospitalized in the medical wards, at the Haemek Medical Center, Israel, were enrolled in the study. Patients treated with anticoagulation, and those admitted for VTE were excluded. Padua score was classified into two categories; low-risk for VTE (<4 points), and high-risk for VTE (≥4 points). Thrombin generation was assessed by the Calibrated Automated Thrombogram (CAT) method.

Overall 187 (73.9%) patients had Padua score<4, and 66 (26.1%) patients had Padua score ≥4. Comparison of the thrombogram parameters between the two Padua score categories showed no significant difference; lag time (P=0.066), ETP (P=0.266), peak height (P=0.418), and time to peak (P=0.415). Among the individual Padua score risk factors, only active cancer was significantly associated with peak height, myocardial infarction or stroke with lag time, and none of the risk factors was significantly associated with ETP. Because of their low frequency, the association with previous VTE, known thrombophilia, hormonal treatment, and recent trauma or/and surgery was not assessed.

Single thrombin generation measurement obtained at the same time in acutely hospitalized patients didn't bear any correlation with the Padua prediction score. This finding should be interpreted with caution considering the underrepresentation of risk factors that may influence thrombin generation.