Overview
Clinical Orientation
An acutely ill inpatient and a patient with a swollen leg raise related but different clinical questions.
An acutely ill inpatient and a patient with a swollen leg raise related but different clinical questions. Is this person at risk of forming a clot, does the presentation suggest an established DVT, and is pulmonary embolism or limb-threatening venous obstruction already developing? The decision tools follow those questions. IMPROVE-DD helps determine whether a hospitalized medical patient needs thromboprophylaxis. Wells scoring and duplex ultrasonography evaluate suspected DVT. Prophylactic anticoagulation prevents clot formation; it does not treat an established DVT, which requires therapeutic anticoagulation. A possible PE, haemodynamic instability, or a painful cyanotic swollen limb takes priority over a routine diagnostic sequence. If DVT probability is high and imaging is delayed, empiric therapeutic anticoagulation is clinician-directed only after checking for active bleeding, platelet abnormalities, renal function, and other treatment limitations.