Dvt_infographic.pdf
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Investigating DVT
Visual summary
An approach to symptoms suggestive of lower limb deep vein thrombosis (DVT)
Clinical suspicion of DVT
Venous clot
Common symptoms: Swelling
Redness
Patients may also be asymptomatic, having had investigation for other conditions such as pulmonary embolism or malignancy
Pain
Typically throbbing in nature, and comes on while walking or bearing weight
Critical features or limb threatened
Swelling and inflammation below site of blockage
Modified Wells score (2003) Active cancer treatment (ongoing, within 6 months, or palliative)
+1
Localised tenderness along distribution of deep venous system
+1
Pitting oedema (greater in symptomatic leg)
+1
Paralysis, paresis, recent immobilisation of the lower limbs Entire leg swelling
Collateral superficial veins (non-varicose)
Total score: –2 –1 0
+1
Recently bedridden for more than 3 days, or major surgery within 4 weeks
+1
+1
Calf swelling >3cm compared with asymptomatic leg
+1
Previous documented DVT
+1
1
2
3
4
DVT unlikely
The D-dimer blood test has high sensitivity but is not very specific. D-dimer can be raised in other conditions, including: Malignancy
Infection
Pregnancy
Post surgery
Inflammation/trauma
Negative
7
8
9
Either proximal or whole leg ultrasound is recommended in high risk cases
Lower limb ultrasound Positive
Proximal, above knee ultrasound is recommended in low risk cases
See more visual summaries
Negative
Positive
Discuss with specialist Consider interim ultrasound or alternate imaging
If diagnostic testing will take longer than 4 hours, begin interim anticoagulation treatment
Read the full article online
Lower limb ultrasound
Positive
Negative
DVT excluded
6
–2
+1
DVT likely
If D-dimer not available or inappropriate
High/moderate sensitive D-dimer test
5
Alternative diagnosis as likely, or more likely than DVT
Treat as DVT
© 2018 BMJ Publishing group Ltd.
http://bit.ly/BMJdvt
Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions, or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/
http://www.bmj.com/infographics
Visual summary
An approach to symptoms suggestive of lower limb deep vein thrombosis (DVT)
Clinical suspicion of DVT
Venous clot
Common symptoms: Swelling
Redness
Patients may also be asymptomatic, having had investigation for other conditions such as pulmonary embolism or malignancy
Pain
Typically throbbing in nature, and comes on while walking or bearing weight
Critical features or limb threatened
Swelling and inflammation below site of blockage
Modified Wells score (2003) Active cancer treatment (ongoing, within 6 months, or palliative)
+1
Localised tenderness along distribution of deep venous system
+1
Pitting oedema (greater in symptomatic leg)
+1
Paralysis, paresis, recent immobilisation of the lower limbs Entire leg swelling
Collateral superficial veins (non-varicose)
Total score: –2 –1 0
+1
Recently bedridden for more than 3 days, or major surgery within 4 weeks
+1
+1
Calf swelling >3cm compared with asymptomatic leg
+1
Previous documented DVT
+1
1
2
3
4
DVT unlikely
The D-dimer blood test has high sensitivity but is not very specific. D-dimer can be raised in other conditions, including: Malignancy
Infection
Pregnancy
Post surgery
Inflammation/trauma
Negative
7
8
9
Either proximal or whole leg ultrasound is recommended in high risk cases
Lower limb ultrasound Positive
Proximal, above knee ultrasound is recommended in low risk cases
See more visual summaries
Negative
Positive
Discuss with specialist Consider interim ultrasound or alternate imaging
If diagnostic testing will take longer than 4 hours, begin interim anticoagulation treatment
Read the full article online
Lower limb ultrasound
Positive
Negative
DVT excluded
6
–2
+1
DVT likely
If D-dimer not available or inappropriate
High/moderate sensitive D-dimer test
5
Alternative diagnosis as likely, or more likely than DVT
Treat as DVT
© 2018 BMJ Publishing group Ltd.
http://bit.ly/BMJdvt
Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions, or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user's own risk. For the full disclaimer wording see BMJ's terms and conditions: http://www.bmj.com/company/legal-information/
http://www.bmj.com/infographics
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