Wells' Criteria for DVT

Like all clinical decision support tools, Wells' DVT standard is designed to help clinical decisions, not mandatory management

Wells' DVT standard is only available to patients considered to be at risk for DVT. If you do not care about DVT, you do not need risk stratification.

According to Wells score, the patient can be divided into "DVT is unlikely" and "DVT possibly" group. Based on the sensitivity of the d-dimer used, you can add additional medium risk groups.

Negative high or medium sensitivity d-dimers give a probability of less than 1% and do not require further imaging

These patients should be examined for high sensitivity d-dimer (medium sensitivity d-dimer deficiency)

In patients with moderate risk, with negative probability of less than 1%, negative high sensitivity d-dimer is sufficient to exclude DVT

The negative US is still concerned about DVT. Repeat the United States must reevaluate within a week

* Moderate risk group should only detect d dimer, ultrasonic examination is not performed when using high sensitivity d dimer.

Decisive rules should not exceed clinical format towers. Regardless of Wells score, high suspicion of DVT should ensure imaging

Wells' DVT standard is used for DVT inspection. The existence of DVT is important for evaluating possible PEs, and if the PEs are in different states, it is necessary to accept alternative decision support such as Wells PE and PERC rules.

Xarelto is an oral Factor Xa inhibitor approved by the FDA in November 2012 for the treatment of DVT or pulmonary embolism (PE) and reduces the risk of recurrence of DVT and PE after initial treatment It is used for. Approval of this indication is based on a total of 9478 studies on DVT patients or PE patients. Participants were randomly assigned to receive a combination of rivaroxaban, enoxaparin and VKA (eg warfarin) or placebo. The endpoint of the study was designed to measure the number of patients with DVT, PE, or recurrence of symptoms after treatment.

In January 2015, Edoxaban (Savaysa) was approved by the FDA for the treatment of DVT and PE in patients initially treated with parenteral anticoagulants for 5-10 days. Approval was based on a Hokusai-VTE study involving 4,921 DVT patients and 3,319 PE patients. In PE patients, 938 has right ventricular dysfunction and is assessed by measuring N-terminal brain natriuretic peptide (NT-proBNP) levels. The prevalence of recurrent VTE was 3.3% in this subgroup of patients treated with etafroxacin and 6.2% in patients taking warfarin. Researchers concluded that Edoxaban is not only inferior to standard warfarin therapy of high quality, but also causes a significant reduction in bleeding in a wide range of VTE patients, including severe PE patients.

The role of movement in the treatment of deep venous thrombosis (DVT) is controversial. In the study of Partsch, myths of new walking and compression in DVT patients were examined and it was concluded that early gait and pressure are not related to significant risk of pulmonary embolism (PE). It can be seen from previous literature that nearly 50% of patients with acute proximal DVT have evidence of asymptomatic PE based on baseline V / Q lung scans. Analyze the effects of walking and compression in this patient cohort and focus on reducing the onset of new PE, pain and swelling, and the incidence and severity of post-thrombotic syndrome (PTS)