Menu
650.617.9907

The Wells test for Pulmonary Embolism. Blood clot risks in the surgical patient.

Home/Blog/The Wells test for Pulmonary Embolism. Blood clot risks in the surgical patient.

Posted on February 16, 2021

I evaluate all my patients for blood clot risk before surgery using the Caprini risk score. I use compression on your legs during the surgery to keep your blood flow moving. I focus on pain control and encourage you to get out of bed and move after surgery. If you need to go on a long car trip or plane ride after surgery for the first 3-4 weeks, I tell you to get up and move around every hour or two.

Even with all of this, you are still at risk.

So how do you know if you have a pulmonary embolism?

Come in, the Wells test. This is not to predict your risk of a blood clot like the Caprini score. This is to try to figure out if you have a pulmonary embolism.  A score of 4 or higher on the Wells test indicates a PE is likely. Why am I writing about this? Because pulmonary embolism is totally tricky. The symptoms are super vague: short of breath, pain with deep breathing, elevated heart rate. I have had few episodes of this, but one patient presented 10 days out with a complaint of “shoulder pain.” Your oxygen saturation level may be normal. You may not have a sign of a blood clot in your leg. The timing can be a week out or a month out from your surgery.

Wells test:

  • Clinical signs and symptoms of DVT  blood clot in your leg SCORE 3
  • PE is #1 diagnosis OR equally likely  SCORE 3
  • Heart rate > 100   SCORE 1.5
  • Immobilization at least 3 days OR surgery in the previous 4 weeks SCORE 1.5
  • Previous, objectively diagnosed PE or DVT  SCORE 1.5
  • Hemoptysis (coughing up blood) SCORE 1
  • Malignancy w/ treatment within 6 months or palliative SCORE 1
Again, a score of 4 or more means PE is likely. I keep thinking of this during this time of Covid. When they do autopsies, they find blood clots. Everywhere. I recently talked to a friend who had a friend with Covid and said he felt okay afterwards except, “the only weird thing is that his resting heartrate went from 55 to over a 100.” When I read this, I think he must have microclots in his lungs.
Why care?
Because even if a pulmonary embolus doesn’t kill you, it is impairing oxygen exchange. It can be a sign there are clots elsewhere. There may still be clot in your leg, and a big clot could block enough of the lung to kill you.

The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.