DVT — suspected deep vein thrombosis

PLAB 2 & PRES 3 · vascular · medium · 8 minutes

Candidate brief

You are an FY2 doctor/SHO in the Emergency Department. Ms Karen O’Neill, 58, has developed pain and swelling in her left calf 3 weeks after knee-replacement surgery. Assess her, explain your concerns and initiate appropriate investigation and management. Verbalise any examinations, investigations and treatments you would undertake.

What examiners look for

Always screen a patient with suspected DVT for symptoms and signs of pulmonary embolism. Use the 2-level DVT Wells score rather than clinical impression alone. A score of 2 or more means DVT likely; 1 or less means DVT unlikely. DVT-likely patients require urgent compression ultrasound. Do not use a negative or positive D-dimer alone to diagnose or exclude DVT in a high-probability patient. If timely imaging is unavailable, assess bleeding risk and consider interim therapeutic anticoagulation according to the applicable pathway. Obtain baseline FBC, renal function, liver function and coagulation tests, but do not allow testing to cause a harmful delay in treatment. Confirmed proximal DVT generally requires anticoagulation for at least 3 months. Medicine selection depends on renal and liver function, bleeding risk, pregnancy, cancer, antiphospholipid syndrome, interactions and patient factors. Explain adherence, medication interactions and bleeding precautions. Avoid non-prescribed NSAIDs such as ibuprofen during anticoagulation unless specifically approved. Provide urgent safety-netting for breathlessness, chest pain, haemoptysis, collapse or significant bleeding.

Guideline references

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