A 68-year-old man develops a swollen, tender left calf 3 days after a hip replacement. His Wells score indicates DVT is likely. What is the next step?
Answer and explanation
Correct answer: A. Start therapeutic anticoagulation and arrange proximal leg ultrasound
- Step 1: A high Wells score means DVT is likely.
- Step 2: NICE advises anticoagulation while awaiting imaging if there is a delay.
Answer
Start therapeutic anticoagulation and arrange proximal leg ultrasound.
Why not the others: Apply a tight bandage and elevate the leg without any further tests: Bandaging alone does not prevent embolism. Prescribe oral ibuprofen and bed rest until the swelling has gone down: NSAIDs and bed rest do not treat clots. Reassure and arrange an outpatient appointment in six weeks to review the leg: Six weeks is too long and unsafe.
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