A 58-year-old woman who underwent hip replacement ten days ago has unilateral leg swelling and tenderness. The Wells score for DVT is calculated as 3. What is the correct next step according to standard practice?

• A D-dimer assay; if negative, discharge without imaging
• B Start therapeutic anticoagulation permanently without imaging
• C Reassure and review in two weeks since the score is below 4
• D Proceed directly to proximal leg vein ultrasound without D-dimer ✓

Explanation

A Wells score above 1 places the patient in the likely category, where B-dimer should be skipped because its high sensitivity cannot safely exclude disease when pretest probability is high, and proximal vein ultrasonography should proceed directly. Using B-dimer first risks false reassurance from a modestly elevated value being misread, and permanent anticoagulation without confirmation is inappropriate.

Reference: NICE Clinical Knowledge Summaries: Venous Thromboembolism, current ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.