Wells Rule Exceptions in DVT: Patients with Cancer or a History of Thrombosis — Physician’s First Watch
Wells Rule Exceptions in DVT: Patients with Cancer or a History of Thrombosis
By Joe Elia
In ruling out deep vein thrombosis, the presence of cancer or a history of DVT gives reason to regard low Wells scores with some skepticism, according to a BMJ study. And in any event, low scores should be buttressed with D-dimer testing.
Researchers examined the ability of the Wells rule to exclude DVT in a patient-level meta-analysis. They used records from 10,000 patients pooled from 13 studies. True DVT was assessed with ultrasonography, venography, or follow-up.
The researchers found that DVT could not be excluded on the basis of the Wells rule alone, but required D-dimer testing (either qualitative or quantitative). Overall, Wells testing plus D-dimer results had a 1.2% false-negative rate; however in patients with active cancers and those with a history of DVT, the false-negative rate exceeded the 2% threshold.