Deep vein thrombosis

Question 1

Clinical features

Answer 1

Localised tenderness along the distribution of the deep venous system in calf/ leg

Pitting oedema

Entire leg swollen

Question 2

Diagnosis

Answer 2

Calculate Wells score:

• 2 or more: DVT likely so do:
  Proximal leg vein ultrasound within 4 hours
  If cannot be done within 4 hours, give LMWH whilst waiting
  If ultrasound negative do D-dimer
• 1 or less: unlikely:
  Do D-dimer
  If positive then manage as if DVT likely

Question 3

Management

Answer 3

LMWH

After diagnosis:

• Warfarin aiming for INR 2-3 with 5 days LMWH coverage
• For 3 months (longer if unprovoked)

Question 4

Extra things to do in an unprovoked DVT or PE

Answer 4

If over 40 over CT CAP

Offer anyone: history, exam, bloods tests (FBC, U+Es, Ca2+, LFTs, urinalysis), CXR