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Cardiovascular
Wells DVT Score
Pre-test probability of deep vein thrombosis to guide D-dimer testing and imaging.
When to use: Apply Wells DVT score to patients presenting with unilateral leg pain, swelling, or erythema to determine pre-test probability before ordering investigations. Low probability (≤0) + negative D-dimer effectively excludes DVT. High probability (≥3) warrants compression ultrasonography regardless of D-dimer. This avoids unnecessary imaging in low-risk patients.
Calculator
Measure 10 cm below tibial tuberosity
E.g., Baker's cyst, cellulitis, muscle strain, post-phlebitic syndrome
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Formula
Wells DVT = Active cancer(1) + Paralysis/plaster(1) + Bedridden >3d/surgery(1) + Tenderness(1) + Entire leg swollen(1) + Calf swelling >3cm(1) + Pitting edema(1) + Collateral veins(1) + Alternative dx (−2)
≤0 = Low (~5%), 1–2 = Moderate (~17%), ≥3 = High (~53%)
Key Points for NEET PG
- Wells DVT: ≤0 = Low (~5%), 1–2 = Moderate (~17%), ≥3 = High (~53%) DVT probability.
- D-dimer is highly sensitive but non-specific — useful to rule OUT DVT in low-probability patients; useless in hospitalised/post-op patients (always elevated).
- Gold standard for DVT diagnosis is Compression Duplex Ultrasonography.
- First-line anticoagulation for DVT: rivaroxaban or apixaban (DOACs); no bridging needed. Warfarin (with LMWH bridge) is an alternative.
- Unprovoked DVT/PE warrants extended anticoagulation and screening for occult malignancy and thrombophilia.
References
Wells PS et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management · Lancet (1997)
Wells PS et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis · N Engl J Med (2003)
For educational purposes only. Not for clinical decision-making without professional oversight.