Wells score for DVT
Wells score for pulmonary embolism
Why surgeons need both
Every surgical patient is at risk of venous thromboembolism. The classic exam scenario is the patient who becomes breathless and tachycardic on day 5 after a laparotomy, or who develops a swollen calf after a hip fracture. The Wells scores decide how likely the diagnosis is, and therefore whether to start with a D-dimer or go straight to imaging.
D-dimer after surgery
A D-dimer is almost always raised after an operation, so in the first weeks after surgery a positive result means little. In the post-operative patient with a likely score, go straight to imaging.
A worked example
Day 6 after an open right hemicolectomy for cancer. She is breathless with a pulse of 112, and her left calf is swollen and tender. PE score: signs of DVT (3) + PE most likely (3) + heart rate over 100 (1.5) + surgery in the last 4 weeks (1.5) + active cancer (1) = 10. PE likely: CTPA now, and start anticoagulation if it is delayed, after weighing the bleeding risk with the operating surgeon.
Not the same as prophylaxis scores
The Wells scores are diagnostic: they help you decide whether a patient has a DVT or PE now. To decide who needs prophylaxis to prevent one, use the Caprini score on the pre-operative risk scores page.
References
- Wells PS, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003;349:1227–35.
- Wells PS, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism. Thromb Haemost 2000;83:416–20.
- NICE NG158. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. 2020 (updated 2023).
Educational use
This calculator is a teaching aid. It does not replace clinical judgement, senior advice or your local guidelines.