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Deep vein thrombosis - Management
How should I manage deep vein thrombosis?

  • If deep vein thrombosis (DVT) is suspected in a woman who is pregnant or who has given birth within the previous 6 weeks, or in a person who is an intravenous drug user, refer immediately for same-day assessment and management.
  • For all other people with a suspected DVT, if D-dimer testing is not available or practical, refer for same-day assessment.
  • If D-dimer testing is available, use the Wells Clinical Prediction Rule to assess the probability of a DVT.
    • Score one point for each of the following:
      • Active cancer (treatment ongoing or within the last 6 months).
      • Paralysis, paresis, or recent plaster immobilization of the legs.
      • Recently bedridden for more than 3 days, or major surgery within the last 12 weeks.
      • Localized tenderness along the distribution of the deep venous system (such as the back of the calf).
      • Entire leg is swollen.
      • Calf swelling by more than 3 cm compared with the asymptomatic leg (measured 10 cm below the tibial tuberosity).
      • Pitting oedema (greater than on the asymptomatic leg).
      • Collateral superficial veins (non-varicose).
      • Previously documented DVT.
    • Subtract two points if an alternative cause is considered more likely than DVT.
    • The risk of DVT is likely if the score is two or more, and unlikely if the score is one or less.
  • Refer people who are likely to have DVT for same-day assessment and management.
  • For people who are unlikely to have DVT:
    • Take a blood sample for D-dimer testing if there is the local facility to do this, and it is reasonably practical and safe to do so (for example the results will be reported that day).
      • If the D-dimer test is positive, refer immediately for further assessment and management.
      • If the D-dimer test is negative, reassure the person, and tell them to seek urgent medical advice if they develop difficulty breathing, increased breathing rate, or chest pain (since these symptoms may indicate pulmonary embolism).

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