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 anticoagulation without delay.
- Computed tomographic 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/fondaparinux.
- In patients with acute VTE, heparin (UFH or LMWH/fondaparinux) should be given for at least four days and until the INR is 2.0 for two consecutive days.
- 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 (not Teds).
- Patient to be treated three to six months for acute thrombosis followed by
re-evaluation of ongoing risks to determine the need for ongoing anticoagulation therapy to prevent recurrent events.
Priority Aims:- Prevent progression or recurrence of thromboembolic disease.
- Reduce the risk of complications from anticoagulation therapy.
- Improve the safety of using medications by reducing the likelihood of patient harm associated with the use of anticoagulation therapy.
- Improve accurate diagnosis and treatment of venous thromboembolism (VTE).
- Increase the percentage of patients who are evaluated upon change in level of care, and/or upon discharge.
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