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Deep Vein Thrombosis — UKMLA MCQ

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HardHematologyDeep Vein ThrombosisUKMLA

A 38-year-old woman with calf discomfort has a two-level DVT Wells score of 0. A laboratory D-dimer result is negative within four hours and she has not started interim anticoagulation. What should happen next?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Exclude DVT, consider alternative diagnoses and provide safety-net advice

A is correct. With a DVT-unlikely Wells score of 1 or less and a negative D-dimer, NICE regards DVT as unlikely: no venous imaging is required, alternative diagnoses should be considered and the patient should receive return advice. B discards a validated rule-out pathway. C exposes her to bleeding without diagnostic justification and repeating D-dimer after treatment is unreliable. D adds radiation and contrast without an indication. E routine serial D-dimer testing is not required after a valid negative result in the DVT-unlikely pathway.

Reference: NICE NG158 — venous thromboembolic diseases: https://www.nice.org.uk/guidance/ng158/chapter/Recommendations