Primary Care Assessment of Suspected Dvt

PRIMARY CARE ASSESSMENT OF SUSPECTED DVT

Section 2

A Two Level Wells Score must be completed by the GP before referral.

Two Level Wells Score- please complete

Clinical feature / Points
Active cancer (treatment ongoing, within 6 months, or palliative) / 1
Paralysis, paresis or recent plaster immobilisation of the lower extremities / 1
Recently bedridden for 3 days or more or major surgery within 12 weeks requiring general or regional anaesthesia / 1
Localised tenderness along the distribution of the deep venous system / 1
Entire leg swollen / 1
Calf swelling at least 3 cm larger than asymptomatic side / 1
Pitting oedema confined to the symptomatic leg / 1
Collateral superficial veins (non-varicose) / 1
Previously documented DVT / 1
An alternative diagnosis is at least as likely as DVT / −2
Clinical probability simplified score:
DVT likely Refer to MAU clinic / 2 points or more
DVT unlikely Refer to flow diagram / 1 point

Section 3

GP Referral Form for MAU Clinic

Please complete all fields for referral to be accepted.

Please book an appointment with MAU quoting the Wells score and email referral to and phone team to confirm receipt.

Patient Name / Patient Address
Patient home phone number
Patient mobile phone number / Patient date of birth
Patient NHS Number
GP Name / GP Address:
GP phone number
GP fax number
Clinical History of DVT / PMH
Medication / Allergies
Wells Score (score overleaf) / Date of Referral
Date of scan/ clinic appointment
If a scan is not available the same day take a D-dimer and prescribe interim anticoagulation

Section 4

Anticoagulation

If an ultrasound scan is not available the same day then take a D-dimer and prescribe interim anticoagulation.

Rivaroxaban
Initiate 15mg orally twice daily after food.
Supply 1 dose for each 12 hours until scan is available

Patients should not be prescribed anticoagulant medication if already on anticoagulation therapy including warfarin or other vitamin K antagonist, low molecular weight heparin, apixaban, dabigatran, edoxaban or rivaroxaban.

Patients with severe renal impairment (less than 30ml/min) may need alternative therapy.

Use with caution in patients with hepatic disease with coagulopathy, pregnancy or breast feeding.

Discuss with the MAU clinic in all above cases.

Section 5

MAU process and follow up

Patients will receive an ultrasound scan to investigate a thrombus. If positive the patient will be continued on rivaroxaban 15mg twice daily for 21 days which will be supplied by the hospital pharmacy.

After 21 days the patient will need to be initiated on 20mg once daily of rivaroxaban for the time period specified by the discharging team.

No routine monitoring is required but anticoagulation may be prolonged if creatinine clearance deteriorates below 30ml/min.

Patients may be initiated on a different anticoagulation where necessary.

A negative scan will be rescanned 6-8 days later. A D-dimer taken in primary care prior to referral can reduce the need for follow up scan by 10%. A further negative scan will be referred for an alternative diagnosis but advice will be given to contact the surgery if symptoms worsen.

GP/Practice nurse to access for below-knee graduated compression stockings with an ankle pressure greater than 23 mmHg to patients with proximal DVT a week after diagnosis or when swelling is reduced sufficiently and if there are no contraindications. Stockings need to be worn for at least two years. The stockings need to be worn only on the affected leg or legs.

Version 1.0