MDCalc

Wells' Criteria for DVT

Calculates risk of DVT based on clinical criteria.

  • Note: The Wells' Score is less useful in hospitalized patients (Silveira PC, 2015).
  • There are a few versions of this criteria with minor differences based on the study; this set is the most widely validated, based on Wells 2003.
Active cancer
Treatment or palliation within 6 months
Bedridden recently >3 days or major surgery within 12 weeks
Calf swelling >3 cm compared to the other leg
Measured 10 cm below tibial tuberosity
Collateral (nonvaricose) superficial veins present
Entire leg swollen
Localized tenderness along the deep venous system
Pitting edema, confined to symptomatic leg
Paralysis, paresis, or recent plaster immobilization of the lower extremity
Previously documented DVT
Alternative diagnosis to DVT as likely or more likely

Result:

Please fill out required fields.
Advice
  • As with all clinical decision aids, the Wells’ DVT criteria is meant to aid clinical decision making and not force management.
  • The Wells’ DVT criteria should only be applied after a detailed history and physical is performed.
  • The Wells’ DVT criteria should only be applied to those patients who have been deemed at risk for DVT. If there is no concern for DVT, then there is no need for risk stratification.
Management

Patients can be divided into “DVT unlikely” and “DVT likely” groups based on Wells score. An additional moderate risk group can be added based on the sensitivity of the d-dimer being used.

  • A score of 0 or lower is associated with DVT unlikely with a prevalence of DVT of 5%.
    • These patients should proceed to d-dimer testing:
      • A negative high or moderate sensitivity d-dimer results in a probability <1 % and no further imaging is required.
      • A positive d-dimer should proceed to US testing.
        • A negative US is sufficient for DVT rule out.
        • A positive US is concerning for DVT; strongly consider treatment with anticoagulation.
  • A score of 1-2 is considered moderate risk with a pretest probability of 17%.*
    • These patients should proceed to high-sensitivity d-dimer testing (moderate sensitivity d-dimer is not sufficient).
      • A negative high-sensitivity d-dimer is sufficient for rule out of DVT in a moderate risk patient with a probability of <1%.
      • A positive high sensitivity d-dimer should proceed to US testing.
        • A negative US is sufficient for ruling out DVT.
        • A positive US is concerning for DVT, strongly consider treatment with anticoagulation.
  • A score of 3 or higher suggests DVT is likely. Pretest probability 17-53%.
    • All DVT likely patients should receive US.
    • D-dimer testing should be utilized to help risk-stratify these DVT-likely patients.
      • In DVT likely patients with negative d-dimer:
        • A negative US is sufficient for ruling out DVT, consider discharge.
        • A positive US should be concerning for DVT, strongly consider treatment with anticoagulation.
      • In DVT likely patients with a positive d-dimer:
        • A positive US should be concerning for DVT, strongly consider treatment with anticoagulation.
        • A negative US is still concerning for DVT. A repeat US should be performed within 1 week for re-evaluation.

*Group should only undergo d-dimer testing for rule out without ultrasonography if a high-sensitivity d-dimer is being used.

Critical Actions
  • No decision rule should trump clinical gestalt. High suspicion for DVT should warrant imaging regardless of Wells score.
  • The Wells’ Criteria for DVT is utilized for the workup of DVT. The presence of DVT is critical to the evaluation of possible PE, and if PE is on the differential, alternative decision aids such as the Wells’ PE or PERC Rule should be entertained.
Have feedback about this calculator?