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