DEEP VENOUS THROMBOSIS
Signs
• Calf tenderness •
Calf warm to touch
• Swelling of the calf
• Mild fever
• Pitting oedema
WELL’S SCORE
• Active cancer (treatment within last 6 months or palliative): +1 point
• Calf swelling ≥ 3 cm compared to asymptomatic calf (measured 10 cm below tibial tuberosity): +1 point
• Swollen unilateral superficial veins (non-varicose, in symptomatic leg): +1 point
• Unilateral pitting edema (in symptomatic leg): +1 point
• Previous documented DVT: +1 point
• Swelling of entire leg: +1 point
• Localized tenderness along the deep venous system: +1 point
• Paralysis, paresis, or recent cast immobilization of lower extremities: +1 point
• Recently bedridden ≥ 3 days, or major surgery requiring regional or general anesthetic in the past 12 weeks: +1 point
• Alternative diagnosis at least as likely: −2 points
- Zero or less than zero points is low probability
- 1-2 points is intermediate probability
- 3 or more points is high probability
Management of Deep venous thrombosis
- IF LOW PROBABILITY do D-dimer as initial investigation
a. If D-dimer –ve it means DVT has been ruled out.
b. If D-dimer +ve then start treatment with heparin and investigate with compression US. If confirmed DVT then add warfarin and continue both warfarin and heparin until INR is 2. When INR is 2 stop heparin and continue warfarin. Maintain INR between 2-3.
2. IF INTERMEDIATE OR HIGH PROBABILITY, DO NOT PERFORM D-DIMER. START TREATMENT with low molecular weight heparin then Investigate with compression ultrasound scan
If +ve then add warfarin and continue both warfarin and heparin until INR is 2 then stop heparin and continue warfarin maintaining INR 2-3.