Wells Criteria for Recurrent DVT
Score 10 clinical variables to determine the pre-test probability of recurrent DVT and guide decisions about compression ultrasound and D-dimer testing.
Use the Wells Criteria for Recurrent DVT
Clinical Variables
Active cancer (+1 pt)
Treatment ongoing, within 6 months, or palliative
Paralysis, paresis, or recent plaster cast (+1 pt)
Affecting the lower extremity
Bedridden ≥ 3 days or major surgery (+1 pt)
Surgery within 12 weeks requiring general or regional anaesthesia
Localized tenderness along deep veins (+1 pt)
Along the distribution of the femoral or popliteal vein
Entire leg swollen (+1 pt)
Compared with the asymptomatic leg
Calf swelling > 3 cm vs. asymptomatic leg (+1 pt)
Measured 10 cm below tibial tuberosity
Pitting edema (+1 pt)
Greater in the symptomatic leg
Collateral superficial veins (+1 pt)
Non-varicose superficial veins in the symptomatic leg
Prior documented DVT (+1 pt)
Objectively confirmed by imaging or venography
Alternative diagnosis at least as likely (-2 pts)
E.g. cellulitis, muscle tear, post-thrombotic syndrome
Result
Wells Score (Recurrent DVT)
—
| Variable | Pts |
|---|---|
| Total |
For clinical decision support only. Always integrate with full history, physical examination, and specialist judgment.
Summary
The modified Wells criteria for recurrent DVT is a clinical decision rule that stratifies pre-test probability in patients with a prior DVT. It evaluates nine positive findings plus whether an alternative diagnosis is at least as likely. A score of 2 or more suggests DVT is likely; a score of 1 or less suggests DVT is unlikely and may support D-dimer testing before imaging.
How it works
- Select Yes or No for each of the 10 clinical variables listed in the scoring panel.
- The calculator sums the points in real time and displays the total score.
- A score of 2 or higher indicates DVT is likely; consider compression ultrasound of both legs.
- A score of 1 or lower indicates DVT is unlikely; D-dimer testing may be used to exclude recurrence.
- Review the interpretation panel for the recommended diagnostic pathway.
- This tool is for clinical decision support only — combine with full clinical assessment.
Use cases
- Assess pre-test probability of recurrent DVT in patients with a prior VTE history.
- Guide the decision to order bilateral compression ultrasound vs. D-dimer first.
- Triage emergency department patients presenting with leg swelling and prior DVT.
- Support anticoagulation management decisions after a suspected recurrent event.
- Teach residents and students about the modified Wells score for DVT recurrence.
- Document clinical risk stratification in medical notes.