Highlights
“The purpose of the guidelines is to present recommendations, based on the current evidence, to clinicians to aid in the diagnosis and management of lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE),” according to lead author Amir Qaseem, MD, of the American College of Physicians in Philadelphia, Pennsylvania.
- Validated clinical prediction rules should be used to estimate pretest probability of VTE, both DVT and PE, and for the basis of interpretation of subsequent tests. Validated clinical prediction rules should be used to estimate probability of VTE, DVT, and PE on the basis of subsequent tests. The Wells prediction rule for DVT is the standard and is based on clinical characteristics (cancer, recently bedridden, swollen leg or calf, edema). For PE, the clinical characteristics are previous embolism, elevated heart rates, and hemoptysis.
- In appropriately selected patients with low pretest probability of DVT or PE, obtaining a high-sensitivity D-dimer is a reasonable option, and if negative, indicates a low likelihood of VTE.
- Ultrasound is recommended for patients with intermediate-to-high pretest probability of DVT in the lower extremities.
- Patients with intermediate or high pretest probability of PE require diagnostic imaging studies.