A man has a swollen, tender calf and a two-level Wells score of 3. The proximal leg vein ultrasound cannot be done for 12 hours. What does NICE advise?
Answer and explanation
Correct answer: B. Give an interim therapeutic dose of a DOAC until the scan can be done
- Step 1: A Wells score of 2 or more makes DVT likely, so a proximal leg vein ultrasound is needed, ideally within 4 hours. Step 2. If it cannot be done in that time, interim anticoagulation is given and the scan is arranged within 24 hours. Answer: Give an interim therapeutic dose of a DOAC until the scan can be done. Why not the others: Discharge without scanning or treating risks propagation and embolus. Aspirin is not treatment. A D-dimer first is the pathway for the unlikely group.
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