Investigation of Deep Vein Thrombosis (DVT)

Investigation of Deep Vein Thrombosis (DVT)

Patient presents with signs and symptoms of Deep Vein Thrombosis
SEE DVT USS HEALTHPATHWAY HERE

Discuss with haematology:
- Red Flags: If new symptoms of chest pain or shortness of breath, discuss with haematology.
- Bilateral DVT scan requires haematology endorsement (provide the name when referring to POAC).
- Children 15-18 years of age (under 15 year olds excluded)
Special Case - Proceed direct to ultrasound*

Superficial ThrombophlebitisUpper Limb (Arm)PregnantRepeat scan within 7-10 days (as advised by haematology/thrombosis team)No special case, calculate wells score (d-dimer ONLY if wells less than 2)
Wells Score Calculation*

Active cancer (treatment in last six months, or palliativeParalysis, paresis or recent plaster immobilisation of lower limbRecent immobilisation >3 days or major surgery <12 weeksLocal tenderness along distribution if deep veinsCalf swelling >3cm compared to asymptomatic side (10cm below tibial tuberosity)Pitting oedema confined to symptomatic legDistended non varicous superficial veinsPreviously documented DVTAlternative diagnosis as/more likely than DVT? (e.g. cellulitis)
Wells Score*
D-Dimer Result*
Age*
Calculation
PROCEED WITH POAC FUNDED COMMUNITY ULTRASOUND.

Submit online referral HERE or via Practice Management System (PMS), email referral to referral@poac.co.nz, call POAC (09) 535 7218 to arrange appointment.
- If delay in scan > 6 hours consider oral rivaroxaban 15mg dose, unless contraindicated (eGFR <15mls/min or pregnant).
- If delay is greater than 24 hours (Friday/weekend presentation), discuss plan with haematology (proceed with scan booking)
- Superficial thrombophlebitis carries 20% risk of underlying DVT
- Bilateral DVT scan requires named haematology endorsement (document on referral)
- Repeat ultrasounds arranged and funded by POAC if required within seven days (all others require e-Referral)
- Refer full HealthPathway here
- If injury related, document ACC number (POAC will fund the ACC co-payment)
- All POAC funded ultrasounds must be approved and arranged by a POAC coordinator
NOT ELIGIBLE FOR COMMUNITY INVESTIGATION OF DVT
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