What are the key clinical features to consider when assessing a patient for suspected DVT?

When assessing a patient for suspected deep vein thrombosis (DVT), key clinical features to consider include:

• Leg swelling: Entire leg swelling or calf swelling at least 3 cm larger than the asymptomatic side is significant.
• Localized tenderness: Tenderness along the distribution of the deep venous system, such as the back of the calf.
• Pitting oedema: Confined to the symptomatic leg.
• Collateral superficial veins: Presence of non-varicose collateral superficial veins.
• Previous history: Documented previous DVT increases suspicion.
• Risk factors: Active cancer (treatment ongoing, within 6 months, or palliative), paralysis, paresis, recent plaster immobilisation of the lower extremities, recent major surgery (within 12 weeks) or prolonged immobilisation (bedridden for 3 days or more).
• Alternative diagnosis: Consider if an alternative diagnosis is at least as likely as DVT, which reduces the probability.

These features are incorporated into the two-level Wells score, which is recommended by NICE to estimate the clinical probability of DVT. A score of 2 points or more indicates DVT is likely, while 1 point or less suggests it is unlikely ¹,².

Additional clinical context includes assessing for signs of pulmonary embolism if relevant, and considering patient-specific factors such as pregnancy or postpartum status, where immediate referral is advised ².

Recent epidemiological and clinical literature supports these clinical features as key indicators for DVT suspicion, emphasizing the importance of combining clinical assessment with risk factor evaluation to guide further diagnostic testing and management (Wolf et al., 2024; Cox and Roberts, 2025).