RAMs used in medical inpatients
| RAM . | Points . |
|---|---|
| Padua VTE RAM: score ≥4 indicates high VTE risk* | |
| Reduced mobility | 3 |
| Active cancer | 3 |
| Previous VTE (excluding superficial thrombophlebitis) | 3 |
| Known thrombophilic condition | 3 |
| Recent trauma and/or surgery (<1 mo) | 2 |
| Elderly age (ie, >70 y) | 1 |
| Heart and/or respiratory failure | 1 |
| Acute myocardial infarction or ischemic stroke | 1 |
| Ongoing hormonal treatment | 1 |
| Obesity (body mass index >30) | 1 |
| Acute infection and/or rheumatologic disorder | 1 |
| IMPROVE VTE RAM: score ≥2 indicates increased VTE risk† | |
| Previous VTE | 3 |
| Known thrombophilia‡ | 2 |
| Lower limb paralysis§ | 2 |
| Active cancer | 2 |
| Immobilization ≥7 d | 1 |
| ICU/CCU stay | 1 |
| Age >60 y | 1 |
| IMPROVE bleeding RAM: score ≥7 indicates high bleeding risk¶ | |
| Renal failure (GFR 30-59 vs ≥60 mL/min per m2) | 1 |
| Male vs female | 1 |
| Age 40-80 vs <40 y | 1.5 |
| Current cancer | 2 |
| Rheumatic disease | 2 |
| Central venous catheter | 2 |
| ICU/Critical Care Unit stay | 2.5 |
| Renal failure (GFR <30 vs ≥60 mL/min per square meter) | 2.5 |
| Hepatic failure (INR > 1.5) | 2.5 |
| Age ≥85 y vs <40 y | 3.5 |
| Platelet count <50 × 109/L | 4 |
| Bleeding in 3 mo before admission | 4 |
| Active gastroduodenal ulcer | 4. 5 |
| RAM . | Points . |
|---|---|
| Padua VTE RAM: score ≥4 indicates high VTE risk* | |
| Reduced mobility | 3 |
| Active cancer | 3 |
| Previous VTE (excluding superficial thrombophlebitis) | 3 |
| Known thrombophilic condition | 3 |
| Recent trauma and/or surgery (<1 mo) | 2 |
| Elderly age (ie, >70 y) | 1 |
| Heart and/or respiratory failure | 1 |
| Acute myocardial infarction or ischemic stroke | 1 |
| Ongoing hormonal treatment | 1 |
| Obesity (body mass index >30) | 1 |
| Acute infection and/or rheumatologic disorder | 1 |
| IMPROVE VTE RAM: score ≥2 indicates increased VTE risk† | |
| Previous VTE | 3 |
| Known thrombophilia‡ | 2 |
| Lower limb paralysis§ | 2 |
| Active cancer | 2 |
| Immobilization ≥7 d | 1 |
| ICU/CCU stay | 1 |
| Age >60 y | 1 |
| IMPROVE bleeding RAM: score ≥7 indicates high bleeding risk¶ | |
| Renal failure (GFR 30-59 vs ≥60 mL/min per m2) | 1 |
| Male vs female | 1 |
| Age 40-80 vs <40 y | 1.5 |
| Current cancer | 2 |
| Rheumatic disease | 2 |
| Central venous catheter | 2 |
| ICU/Critical Care Unit stay | 2.5 |
| Renal failure (GFR <30 vs ≥60 mL/min per square meter) | 2.5 |
| Hepatic failure (INR > 1.5) | 2.5 |
| Age ≥85 y vs <40 y | 3.5 |
| Platelet count <50 × 109/L | 4 |
| Bleeding in 3 mo before admission | 4 |
| Active gastroduodenal ulcer | 4. 5 |
CI, confidence interval; CCU, Coronary Care Unit; GFR, glomerular filtration rate; ICU, Intensive Care Unit; INR, international normalized ratio.
VTE incidence without VTE prophylaxis:
Padua score 0 to 3: 0.3%
Padua score ≥ 4: 11%
Among at-risk patients (Padua score ≥ 4)
Overall VTE hazard ratio (HR), 32 (95% CI, 4.1-251)
Incidence of VTE
No prophylaxis: 11%
With prophylaxis: 2.2%
VTE HR with prophylaxis, 0.13 (95% CI, 0.04-0.4)
Incidence of major or clinically relevant nonmajor bleeding with prophylaxis = 1.6% (95% CI, 0.5-4.6)
Interpretation: among at-risk patients (Padua score ≥ 4), the reduction in VTE appears to outweigh the increased risk of bleeding with pharmacologic prophylaxis.
A total of 69% of patients in this study37 were low risk for VTE (score 0 or 1).
Three-month rate of symptomatic VTE:
IMPROVE VTE score 0 or 1: 0.5%
IMPROVE VTE score 2 or 3: 1.5%
IMPROVE VTE score ≥ 4: 5.7%.
Incidence of major bleeding/any bleeding:
IMPROVE bleeding score < 7: 0.4%/1.5%
IMPROVE bleeding score ≥ 7: 4.1%/7.9%.
A total of 60.3% of patients in this study were low risk (Padua score 0-3). VTE prophylaxis was administered by provider choice from among several medications and with or without concomitant compression stockings.36
Risk level: score of 0 or 1 = low risk, score of 2 or 3 = moderate risk; score ≥ 4 = high risk. For scores ≥ 2, VTE prophylaxis is indicated.
Congenital or acquired thrombophilic condition (eg, factor V Leiden, lupus anticoagulant, protein C, or protein S deficiency).
Leg falls to bed by 5 seconds but has some effort against gravity using the National Institutes of Health stroke scale.
About 90% of patients in this study40 were low risk for bleeding (score < 7).