Is it DVT?

Last night I saw a 36 yo man who had a worsening painful swelling in his calf and had been lying in bed for the past 4 days due to this concern. His BP was 189/115 pulse 95% and pulse ox 98%. There were discrete, tender 2cm wide palpable cords just below the skin. He also had a tender nodularity on the same side near the femoral vein. I calculated his Wells score = 2 (localized tenderness along distribution of deep venous system + bedridden >3d) and had to refer him to the ED as I had no access to a lab or ultrasound. The ED gave him fondaparinux and scheduled an ultrasound  for the next day, today, and it is still pending.

I also had a case last month of a 60 yo man with open hernia repair 9 days prior to the visit with me who complained of right thigh numbness which he had experienced in the past, before his surgery. His daughter, who was at the visit, had had a DVT and PE the year prior and her only complaint was numbness in her foot, so he was concerned. His exam was unremarkable. My suspicion was low and his Wells score = -1 (+1 recent surgery, -2 for alternate diagnosis likely). Still, I gave in to his family's concerns and ordered a D-dimer, which came back elevated, probably due to recent surgery. At Kaiser after-hours, where this was all happening, their practice is also to anticoagulate until regular hours then ultrasound can be done. So we had to calculte his lovenox dose (the patient was obese and could not use fondaparinux), teach him and his reluctant family how to give the twice-daily injections, and schedule the ultrasound, which was negative.

Did I apply current best practice to these situations? I do feel that in the former case a D-dimer (and likely ultrasound) was needed to be sure the patient did not have DVT. In the latter I'm less certain. With a Wells score of -1 I could have been more reassuring and saved the patient and his family the inconveniences of the 24-hours following the initial visit. On the other hand, they were hesitant to be reassured by my clinical assessment.

Any thoughts on how to handle either of these cases differently?

Reference: Is it DVT? Wells score and D-dimer may avert costly workup. Journal of Family Practice Vol 56, no. 12. December 2007. (http://www.jfponline.com/pdf%2f5612%2f5612JFP_Purl2.pdf)