Lower-Limb Deep Vein Thrombosis (DVT) — Diagnostic Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Wells-DVT score
   Wells-DVT score (two-level)? (+1 each: active cancer, leg paralysis/immobilization/recent cast, bedridden ≥3 days or major surgery ≤12 weeks, tenderness along deep veins, whole-leg swelling, calf circumference >3 cm vs the other side, pitting edema of the affected leg, collateral superficial veins (non-varicose), previous DVT (+1); an equally likely alternative diagnosis (−2). ≤1 = 'unlikely', ≥2 = 'likely'.)
   • Likely (≥2) → Compression ultrasound
   • Unlikely (≤1) → D-dimer
2. [Decision] D-dimer
   High-sensitivity D-dimer result? (For 'unlikely', check a high-sensitivity D-dimer (an age-adjusted threshold may be used).)
   • Negative → DVT excluded
   • Positive → Compression ultrasound
3. [End] DVT excluded
   'Unlikely' + negative D-dimer: DVT can essentially be excluded without imaging; give return advice and follow up if needed.
4. [End] Compression ultrasound
   Compression ultrasound (proximal veins): 'likely' patients go straight to ultrasound (regardless of D-dimer); positive → DVT confirmed, start anticoagulation (DOAC, or LMWH bridging to a DOAC); negative but high clinical suspicion → repeat at 1 week or use D-dimer to help. After confirmation, find the provoking factor, assess bleeding risk and duration of therapy.

Source guidelines & references

• Wells PS, et al. Clinical prediction score for DVT. N Engl J Med / Lancet
• National venous thromboembolism (VTE) diagnostic guidelines

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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