Are you at risk for DVT?
- Check all the statements that apply to you.
- Enter the number of points shown for each of your checked statements in the space at the right.
- Add up all your points to reach your total DVT risk score.
Add 5 points for each of the following statements that apply:
___ Recent hip or knee joint replacement
___ Broken hip, pelvis or leg within the past month
___ Stroke within the last month
___ Serious trauma within the last month (for
example, a fall, broken bone or car accident)
___ Spinal cord injury resulting in paralysis within
the last month
Add 3 points for each of the following statements that apply:
___ Age 75 or over
___ History of blood clots, either DVT or PE
___ Family history of blood clots
___ Family history of blood-clotting disorders
Add 2 points for each of the following statements that apply:
___ Age 60-74 years
___ Recent arthroscopic knee surgery
___ Cancer (current or previous)
___ Recent major surgery that lasted
longer than 45 minutes
___ Recent laparoscopic surgery that lasted
longer than 45 minutes
___ Recently confined to bed rest for
more than 72 hours
___ Plaster cast that has kept you from moving your limb within the last month
___ Tube in blood vessel in neck/chest that delivers blood or medicine to heart
For WOMEN only: Add 1 point for each of the following statements that are true:
___ Use of birth control or hormone replacement
___ Pregnant or had a baby within the last month
Add 1 point for each of the following statements that are true:
___ Age 41-60 years
___ Planning minor surgery in the near future
___ Had major surgery within the last month
___ Varicose veins
___ History of inflammatory bowel disease
___ Legs are currently swollen
___ Overweight or obese
___ Heart attack within the last month
___ Congestive heart failure within the last month
___ Serious infection within the last month
___ Lung disease within the last month
___ Currently on bed rest or restricted mobility
Add up all your points to get your total DVT risk score _______
What does your DVT risk score mean?
0-1 – Low Risk - What should you do about it? Although you are not at risk right now, it’s a good idea to reassess your risk for DVT at regularly scheduled doctor visits.
2 – Moderate Risk - What should you do about it? Share your answers with your doctor at your next appointment so that he or she can address your risk.
3+ - High Risk - What should you do about it? Your increased risk requires you to share your answers with your doctor so that he or she can address your risk.
More information about DVT diagnosis and treatment.
