Deep vein thrombosis natural history, complications and prognosis
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
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Probability scoring
In 2006, Scarvelis and Wells overviewed a set of clinical prediction rules for DVT,[1] on the heels of a widely adopted set of clinical criteria for pulmonary embolism.[2][3]
Wells score or criteria
(Possible score -2 to 9)
- 1) Active cancer (treatment within last 6 months or palliative) -- 1 point
- 2) Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point
- 3) Collateral superficial veins (non-varicose) -- 1 point
- 4) Pitting edema (confined to symptomatic leg) -- 1 point
- 5) Swelling of entire leg - 1 point
- 6) Localized pain along distribution of deep venous system -- 1 point
- 7) Paralysis, paresis, or recent cast immobilization of lower extremities -- 1 point
- 8) Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks -- 1 point
- 9) Previously documented DVT -- 1 point
- 10) Alternative diagnosis at least as likely -- Subtract 2 points
Interpretation
- Score of 2 or higher - deep vein thrombosis is likely. Consider imaging the leg veins.
- Score of less than 2 - deep vein thrombosis is unlikely. Consider blood test such as d-dimer test to further rule out deep vein thrombosis.
- ↑ Scarvelis D, Wells P (2006). "Diagnosis and treatment of deep-vein thrombosis". CMAJ. 175 (9): 1087–92. PMID 17060659. Free Full Text.
- ↑ Neff MJ. ACEP releases clinical policy on evaluation and management of pulmonary embolism. American Family Physician. 2003; 68(4):759-?. Available at: http://www.aafp.org/afp/20030815/practice.html. Accessed on: December 8, 2006.
- ↑ Wells P, Anderson D, Rodger M, Ginsberg J, Kearon C, Gent M, Turpie A, Bormanis J, Weitz J, Chamberlain M, Bowie D, Barnes D, Hirsh J (2000). "Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer". Thromb Haemost. 83 (3): 416–20. PMID 10744147.