scholarly journals A study on the effectiveness of wells criteria for diagnosing deep vein thrombosis: a prospective observational study

2021 ◽  
Vol 8 (2) ◽  
pp. 569
Author(s):  
Dhanaraj Palanisamy ◽  
Akshay Omkumar
Keyword(s):  
Deep Vein Thrombosis ◽  
Single Case ◽  
Post Partum ◽  
Clinical Signs ◽  
Study Group ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein

Background: Wells score which takes into account various aspects in the history as well as various clinical signs which can help the clinician to arrive at a diagnosis of deep vein thrombosis (DVT). This helps to save time and money that is wasted in doing many unnecessary investigations. Aim of the study was to test the application of the Wells score in our clinical set up and to see how effectively we can diagnose DVT.Methods: This was a prospective diagnostic validation study of the wells rule for DVT in our setup, ultrasound (USG) being the gold standard comparison and will be conducted over a duration of 12 months. Wells score for each patient was calculated and the results were evaluated.Results: Among the 50 cases suspected DVT, the wells score was able to predict DVT in 46 of the cases thus proving to be a very efficient diagnostic indicator. The average wells score among the various cases was 4/8. Complications noted in the study group were 2 cases of cortical vein thrombosis in the post-partum period which fully recovered. Mortality rate in the study group was 4.3% in which a single case of diagnosed myocardial infarction died of heart failure.Conclusions: Wells score is indeed a very good predictive criteria for DVT and can be applied with ease as it required only clinical assessment and thus avoids unnecessary delays in waiting for scans thereby allowing us to start anticoagulants as early as possible.

Intensive Initial Oral Anticoagulation and Shorter Heparin Treatment in Deep Vein Thrombosis

1984 ◽  
Vol 52 (03) ◽  
pp. 276-280 ◽  
Author(s):  
Sam Schulman ◽  
Dieter Lockner ◽  
Kurt Bergström ◽  
Margareta Blombäck
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulation ◽  
Dose Group ◽  
Low Dose ◽  
Clinical Signs ◽  
Coagulation Factor ◽  
High Dose ◽  
Vein Thrombosis ◽  
Heparin Treatment ◽  
Deep Vein

SummaryIn order to investigate whether a more intensive initial oral anticoagulation still would be safe and effective, we performed a prospective randomized study in patients with deep vein thrombosis. They received either the conventional regimen of oral anticoagulation (“low-dose”) and heparin or a more intense oral anticoagulation (“high-dose”) with a shorter period of heparin treatment.In the first part of the study 129 patients were randomized. The “low-dose” group reached a stable therapeutic prothrombin complex (PT)-level after 4.3 and the “high-dose” group after 3.3 days. Heparin was discontinued after 6.0 and 5.0 days respectively. There was no difference in significant hemorrhage between the groups, and no clinical signs of progression of the thrombosis.In the second part of the study another 40 patients were randomized, followed with coagulation factor II, VII, IX and X and with repeated venograms. A stable therapeutic PT-level was achieved after 4.4 (“low-dose”) and 3.7 (“high-dose”) days, and heparin was discontinued after 5.4 and 4.4 days respectively. There were no clinical hemorrhages, the activity of the coagulation factors had dropped to the same level in both groups at the time when heparin was discontinued and no thromboembolic complications occurred.Our oral anticoagulation regimen with heparin treatment for an average of 4.4-5 days seems safe and reduces in-patient costs.

Performance of the Wells score in predicting deep vein thrombosis in medical and surgical hospitalized patients with or without thromboprophylaxis: The R-WITT study

2021 ◽  
pp. 1358863X2199467
Author(s):  
Jean-Eudes Trihan ◽  
Michael Adam ◽  
Sara Jidal ◽  
Isabelle Aichoun ◽  
Sarah Coudray ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Operating Characteristics ◽  
Vein Thrombosis ◽  
Ultrasound Study ◽  
Wells Score ◽  
Deep Vein ◽  
The Impact ◽  
Test Probability

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

scholarly journals INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

2018 ◽  
Vol 11 (5) ◽  
pp. 377
Author(s):  
Morteza Habibi Moghadam ◽  
Marzieh Asadizaker ◽  
Simin Jahani ◽  
Elham Maraghi ◽  
Hakimeh Saadatifar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
Intervention Group ◽  
Control Group ◽  
Nursing Interventions ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein ◽  
Pitting Edema

 Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

scholarly journals Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

2013 ◽  
Vol 12 (2) ◽  
pp. 118-122
Author(s):  
Liz Andrea Villela Baroncini ◽  
Graciliano Jose Franca ◽  
Aguinaldo de Oliveira ◽  
Enrique AntonioVidal ◽  
Carlos Eduardo Del Valle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Below The Knee ◽  
Clinical Conditions ◽  
Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

Repeat duplex ultrasound scanning in suspected Deep Vein Thrombosis (DVT): putting the onus back on the referring clinician

2016 ◽  
Vol 15 (2) ◽  
pp. 63-67
Author(s):  
Bryan Renton ◽  
S Thiru ◽  
CP Griffin
Keyword(s):  
Deep Vein Thrombosis ◽  
Duplex Ultrasound ◽  
Ultrasound Scanning ◽  
Nice Guideline ◽  
Vein Thrombosis ◽  
Dramatic Rise ◽  
Wells Score ◽  
Deep Vein ◽  
Repeat Scanning ◽  
D Dimer

Duplex scanning is utilised by many departments in the investigation of suspected Deep Vein Thrombosis (DVT). NICE Guideline CG144 recommended repeat scanning for patients in whom the initial Wells score was ‘likely’ in the presence of a raised D-Dimer, following a normal first scan. Following implementation of this recommendation in our department there was a dramatic rise in the number of repeat scans being undertaken, all of which were negative for DVT. Introduction of an electronic message to the report, placing the onus back on the referring clinician to arrange repeat scan if deemed appropriate resulted in a fall in the number of scans being undertaken without impacting on patient outcome.

scholarly journals P001: Age-adjusted D-dimer and two-site compression point of care ultrasonography to rule out acute deep vein thrombosis - a pilot study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S57-S57
Author(s):  
K. Alqaydi ◽  
J. Turner ◽  
L. Robichaud ◽  
D. Hamad ◽  
X. Xue ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Point Of Care ◽  
Screening Tools ◽  
Duplex Scan ◽  
Vein Thrombosis ◽  
Wells Score ◽  
Deep Vein ◽  
D Dimer ◽  
Rule Out

Introduction: Deep vein thrombosis (DVT) can lead to significant morbidity and mortality if not diagnosed and treated promptly. Currently, few methods aside from venous duplex scanning can rule out DVT in patients presenting to the Emergency Department (ED). Current screening tools, including the use of the subjective Wells score, frequently leads to unnecessary investigations and anticoagulation. In this study, we sought to determine whether two-site compression point-of-care ultrasound (POCUS) combined with a negative age-adjusted D-dimer test can accurately rule out DVT in ED patients irrespective of the modified Wells score. Methods: This is a single-center, prospective observational study in the ED of the Jewish General Hospital in Montreal. We are recruiting a convenience sample of patients presenting to the ED with symptoms suggestive of DVT. All enrolled patients are risk-stratified using the modified Wells criteria for DVT, then undergo two-site compression POCUS, and testing for age-adjusted D-dimer. Patients with DVT unlikely according to modified Wells score, negative POCUS and negative age-adjusted D-dimer are discharged home and receive a three-month phone follow-up. Patients with DVT likely according to modified Wells score, a positive POCUS or a positive age-adjusted D-dimer, will undergo a venous duplex scan. A true negative DVT is defined as either a negative venous duplex scan or a negative follow-up phone questionnaire for patients who were sent home without a venous duplex scan. Results: Of the 42 patients recruited thus far, the mean age is 56 years old and 42.8% are male. Twelve (28.6%) patients had DVT unlikely as per modified Wells score, negative POCUS and negative age-adjusted D-dimer and were discharged home. None of these patients developed a DVT on three-month follow-up. Thirty patients (71.4%) had either a DVT likely as per modified Wells score, a positive POCUS or a positive age-adjusted D-dimer and underwent a venous duplex scan. Of those, six patients had a confirmed DVT (3 proximal & 3 distal). POCUS detected all proximal DVTs, while combined POCUS and age-adjusted D-dimer detected all proximal and distal DVTs. None of the patients with a negative POCUS and age-adjusted D-dimer were found to have a DVT. Conclusion: Two-site compression POCUS combined with a negative age-adjusted D-dimer test appears to accurately rule out DVT in ED patients without the need for follow-up duplex venous scan. Using this approach would alleviate the need to calculate the Wells score, and also reduce the need for radiology-performed duplex venous scan for many patients.

scholarly journals Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Eleftheria Kampouri ◽  
Paraskevas Filippidis ◽  
Benjamin Viala ◽  
Marie Méan ◽  
Olivier Pantet ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Retrospective Study ◽  
University Hospital ◽  
Thromboembolic Events ◽  
Vein Thrombosis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Wells Score ◽  
Deep Vein ◽  
D Dimer

Background. Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results. Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120   ng / ml ( P < 0.001 ; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation ( P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000   ng / l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611   ng / ml ( P < 0.001 ; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation ( P < 0.001 ; OR 5.9, 95% CI 2.3-15.1). Conclusions. VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000   ng / l is a good predictor of VTE at admission.

CLINICAL SIGNS OF DEEP-VEIN THROMBOSIS

The Lancet ◽  
1972 ◽  
Vol 299 (7745) ◽  
pp. 321 ◽  
Author(s):  
I.J.T. Davies
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Signs ◽  
Vein Thrombosis ◽  
Deep Vein
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