DVT

Question 1

What do we use to score DVT

Answer 1

Well’s criteria

Question 2

Wells score ≥ 2

Answer 2

ABCD(CD)E(CDE)4Ps

• Another diagnosis is as likely as DVT: -2
• Bedridden last 3 days or Big surgery recently: 1
• Cancer: 1
  DEEP VENOUS INVOLVEMENT
• Collateral superficial veins (non varicose) present: 1
• Deep vein tenderness in leg: 1
  EDEMA
• Calf swelling at least 3cm larger than other leg: 1
• Denting (pitting) oedema on leg: 1
• Entire leg swollen: 1
  4Ps
• Paralysis, paresis or recent immobilisation of legs: 1
  Previous DVT: 1

<2 - DVT unlikely, ≥2 - DVT likely

Question 3

Well’s score < 2

Answer 3

D-dimer within 4 hours, if not possible start interim anticoagulation

Question 4

What is used to confirm DVT

Answer 4

Proximal leg US within 4 hours, or D dimer + anticoagulation + scan within 24 hours

Question 5

DVT management

Answer 5

DOACs
2nd line = LMWH

Provoked = 3 months
Unprovoked = 6 months

Question 6

How does DVT present

Answer 6

Unilateral warm swollen leg that is tender to touch - there may be distension of superficial veins and pitting oedema too

Question 7

What do you do if d-Dimer is negative

Answer 7

Rules out DVT - d-dimer has high sensitivity low specificity, therefore it will always be up in DVT. If negative, consider alternative diagnosis