Scope and Target Population:Adult patients age 18 and over with venous thromboembolism (VTE).
Clinicians Highlights and Recommendations:- A clinical pretest probability assessment should be completed in patients with suspected venous thromboembolism.
- D-dimer can be used as a negative predictor to eliminate need for further testing.
- Confirm diagnosis of DVT with imaging study, preferably duplex ultrasound (with compression).
- In patients with a high clinical pretest probability for PE, begin LMWH without delay.
- CT angiography combined with clinical pretest probability scoring and D-dimer testing has the predictive value to safely diagnose or rule out pulmonary embolism in patients. Additional diagnostic testing is necessary only when clinical symptoms persist or progress.
- Achieve rapid effective anticoagulation with LMWH.
- In patients with acute VTE, heparin (UFH or LMWH) should be given for at least four days and until the INR is 2.0 for two consecutive times.
- Arrange for home therapy in appropriate patients.
- Graded compression stockings help prevent post-phlebotic syndrome. All patients should be assessed for the need for compression graded stockings.
Priority Aims:- Prevent progression or recurrence of thromboembolic disease.
- Reduce the risk of complications from anticoagulation therapy.
- Improve quality of care and cost effectiveness of the diagnosis and treatment of VTE.
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