Investigating DVT
[Pages:1]Visual summary
Investigating DVT
An approach to symptoms suggestive of lower limb deep vein thrombosis (DVT)
Clinical suspicion of DVT
Common symptoms: Swelling Redness Pain
Typically throbbing in nature, and comes on while walking or bearing weight
Patients may also be asymptomatic, having had investigation for other conditions such as pulmonary embolism or malignancy
Critical features or limb
threatened
Venous clot
Swelling and inflammation below
site of blockage
Active cancer treatment
(ongoing, within 6
+1
months, or palliative)
Localised tenderness along
distribution of deep venous +1
system
Pitting oedema (greater
in symptomatic leg)
+1
Modi ed Wells score (2003)
Paralysis, paresis, recent
immobilisation of the
+1
lower limbs
Entire leg swelling
+1
Collateral superficial
veins (non-varicose)
+1
Recently bedridden for
more than 3 days, or major +1
surgery within 4 weeks
Calf swelling >3cm
compared with
+1
asymptomatic leg
Previous documented
DVT
+1
Total score: ?2 ?1 0 1 2 3 4 5 6 7 8 9
DVT unlikely
DVT likely
Alternative diagnosis as likely, or more likely than DVT
?2
The D-dimer blood test has high sensitivity but is not very specific. D-dimer can be raised in other conditions, including:
Malignancy Infection
Pregnancy Post surgery
Inflammation/trauma
High/moderate sensitive D-dimer test
Negative
Positive
If D-dimer not available or inappropriate
Either proximal or whole leg ultrasound is recommended in high risk cases
Lower limb ultrasound
Negative
Positive
Lower limb ultrasound
Negative
Positive
Proximal, above knee ultrasound is recommended in low risk cases
Discuss with specialist
Consider interim ultrasound or alternate imaging
DVT excluded
If diagnostic testing will take longer than 4 hours, begin interim anticoagulation treatment
Treat as DVT
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? 2018 BMJ Publishing group Ltd.
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