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Deep vein thrombosis - Management
Basis for recommendation
- Recommendations for suspecting deep vein thrombosis (DVT), and possible differential diagnoses, are based on expert opinion in narrative reviews [Anand et al, 1998; Gorman et al, 2000; Tovey and Wyatt, 2003].
- Individual symptoms and signs are, on their own, poorly predictive of the presence or absence of DVT [Goodacre et al, 2005].
- Therefore, the diagnosis of DVT should be made using a clinical prediction guide such as the Wells Clinical Prediction Rule, which is scored using the sum of the most sensitive and specific risk factors and signs (see Management of DVT).
- Homans' sign (pain in the calf or popliteal region on passive, abrupt, forceful dorsiflexion of the ankle with the knee in a flexed position) is not now used in the assessment of DVT, as it is insensitive and nonspecific, can be painful, and there is a theoretical possibility of dislodging a thrombus.
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