Venous Thrombosis: The Daily PANCE Blueprint
A 68-year-old male presents to the clinic with left leg swelling and tenderness after being bedridden for a week following hip surgery. His Wells score indicates a high probability of a deep venous thrombosis. Which of the following is the most appropriate next diagnostic test?
A. D-dimer assay
B. CT angiography
C. Venous duplex ultrasound
D. MRI of the leg
E. Contrast venography
Answer and topic summary
The answer is C. Venous duplex ultrasound
Knowing what to order for a suspected deep venous thrombosis (DVT) is important! This patient needs a venous ultrasound because he is at a high risk of a DVT. Ordering a d-dimer would be useless in this situation. Many things, not just clots, can elevate d-dimer levels.
Well’s Score for DVT (helpful in outpatient settings) helps us determine the patient’s risk for DVT based on these criteria: active cancer, bedridden or surgery, calf swelling, collateral veins presence, entire leg swollen, localized tenderness along deep venous system, pitting edema confined to affected leg, recent immobilization, previous DVT, alternative diagnosis as or more likely.
The bottom line is that a d-dimer should be ordered in low-risk patients, and a venous duplex US should be ordered for high-risk patients.
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