Wells’ Criteria for Deep Vein Thrombosis

The Wells’ Criteria for deep vein thrombosis (DVT) can be used to estimate the probability of DVT based on the patient history and clinical criteria. This provides a recommendation for further diagnostics depending on the pre-test probability.

Active cancer
Treatment within the last 6 months or palliative therapy
Paralysis, paresis, recent immobilization of lower extremities
Bedridden (≥ 3 days) or major surgery in the last 12 weeks
Localized pain or induration along the deep venous system
Whole leg swollen
Calf swelling (≥ 3 cm/1.2 inch) in a side by side comparison
measured 10 cm/3.9 inch below the tibial tuberosity
Pitting edema on the symptomatic leg
Superficial (non-varicose) collateral veins
Previously documented deep vein thrombosis
Alternative diagnosis to deep vein thrombosis as likely or more likely

Wells’ Criteria for Deep Vein Thrombosis:

Recommendation:

Interpretation
Score Classification and recommendation
≤ 1

Deep vein thrombosis unlikely

Recommendation: perform D-dimer test

  • If D-dimer is negative, deep vein thrombosis can be excluded.
  • If D-dimer is positive, duplex sonography should be performed to exclude deep vein thrombosis.
≥ 2

Deep vein thrombosis likely

Recommendation: Duplex sonography should be performed to exclude deep vein thrombosis.
References
  1. Wells PS, Anderson DR, Rodger M et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349: 1227-1235

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