Deep Vein Thrombosis (DVT)

Question 1

what is a deep vein thrombosis (DVT)?

Answer 1

the formation of a thrombus within the deep venous system, most often occurring in the veins of the leg but also in the pelvis and arm

Question 2

what are the symptoms of a DVT?

Answer 2

• oedema
• pain (e.g. cramping)
• erythema
• peripheral venous distension

Question 3

what is the management of a DVT (e.g. wells ≥2)?

Answer 3

• proximal leg vein doppler US
• if the US is positive: treat the DVT with an anticoagulant
• if the US can’t be done within 4 hours: D-dimer and offer an interim anticoagulant until results are available
• if the US is negative: check the D-dimer. if it is positive, repeat the scan in 6-8 days (stop interim coagulation if started)

Question 4

what is the management of a DVT (e.g. wells <2)?

Answer 4

• D-dimer
• if the D-dimer is positive: offer a proximal leg vein doppler US or provide interim coagulation if US results cannot be obtained within four hours. if the US is positive treat the DVT with an anticoagulant
• if the D-dimer results can’t be obtained within four hours: offer interim anticoagulation until results are available
• if the D-Dimer is negative: another diagnosis should be considered and no anticoagulation given

Question 5

what scoring system should be used if a DVT is suspected?

Answer 5

two-level wells score

Question 6

what is the ‘rule of 3s’ for the two-level wells score for DVT?

Answer 6

• bedridden for 3 days
• surgery in the last 3 months
• leg 3cm larger

Question 7

what is the interpretation of the two-level wells score for DVT?

Answer 7

DVT likely: ≥2 points
DVT unlikely: <2 points