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A Practical Guide to Haemostasis


Investigation of a suspected DVT:
The Wells Score

Introduction:

The Wells score is used to evaluate a patient with a suspected DVT to establish the probability that this is is likely or unlikely.  The Wells score is frequently then combined with D-dimer estimation to guide further investigation/management - see below.

The Wells DVT Score:


Select Criteria:

Active cancer [ongoing treatment or within the previous 6 months or palliative]
1 Point
Paralysis, paresis or recent plaster immobilisation of the lower limbs
1 Point
Recently confined to bed for 3+ days or major surgery within the previous 12 weeks requiring general or regional anaesthesia
1 Point
Localised tenderness along the distribution of the deep venous system
1 Point
Entire leg swelling
1 Point
Calf swelling at least 3cm larger that of the asymptomatic leg [measured 10cm below the tibial tuberosity]
1 Point
Pitting oedema confined to the symptomatic leg
1 Point
Collateral superficial veins [non-varicose veins]
1 Point
Previously documented DVT
1 Point
Alternative diagnosis at least as likely as DVT
-2 Points

Score

Interpretation
≤ 1 Point Low probability for DVT
≥ 2 Points Intermediate/high probability for DVT


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Comments:


The Wells Score is frequently combined with D-dimer estimation to guide further investigation/management: 

Investigation of the Wells score with D-dimer and Ultrasound object=