Wells Criteria for DVT (Deep Vein Thrombosis)

Wells Criteria for DVT (Deep Vein Thrombosis)

Clinical prediction rule for DVT probability assessment.

Active malignancy within 6 months or palliative treatment

+1 points

Recent immobilization or paralysis of the affected leg

+1 points

Prolonged bed rest or recent major surgery

+1 points

Tenderness along the deep venous system

+1 points

Swelling of the entire affected leg

+1 points

Calf swelling >3 cm compared to asymptomatic leg

+1 points

Pitting edema only in the symptomatic leg

+1 points

Presence of collateral superficial veins

+1 points

History of previous deep vein thrombosis

+1 points

Alternative diagnosis equally or more likely than DVT

-2 points

Wells Score Interpretation

Low probability (0 or less): 3% prevalence of DVT
Moderate probability (1-2): 17% prevalence of DVT
High probability (3 or more): 75% prevalence of DVT

Clinical Management

  • Low probability: D-dimer testing. If negative, DVT ruled out
  • Moderate probability: D-dimer and/or imaging studies
  • High probability: Consider immediate imaging, D-dimer may not be needed
  • Always use clinical judgment in addition to the score

References

  • Wells PS, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349(13):1227-1235.
  • Wells PS, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-1798.
  • Kearon C, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.

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