Abstract

BACKGROUND
Objective testing for DVT is crucial because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. This guideline focuses on the identification of optimal strategies for the diagnosis of DVT in ambulatory adults.
METHODS
The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
RESULTS
We suggest that clinical assessment of pretest probability of DVT, rather than performing the same tests in all patients, should guide the diagnostic process for a first lower extremity DVT (Grade 2B). In patients with a low pretest probability of first lower extremity DVT, we recommend initial testing with D-dimer or ultrasound (US) of the proximal veins over no diagnostic testing (Grade 1B), venography (Grade 1B), or whole-leg US (Grade 2B). In patients with moderate pretest probability, we recommend initial testing with a highly sensitive D-dimer, proximal compression US, or whole-leg US rather than no testing (Grade 1B) or venography (Grade 1B). In patients with a high pretest probability, we recommend proximal compression or whole-leg US over no testing (Grade 1B) or venography (Grade 1B).
CONCLUSIONS
Favored strategies for diagnosis of first DVT combine use of pretest probability assessment, D-dimer, and US. There is lower-quality evidence available to guide diagnosis of recurrent DVT, upper extremity DVT, and DVT during pregnancy.

Links

Publisher Full Text

Authors

Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD, Kearon C, Schunemann HJ, Crowther M, Pauker SG, Makdissi R, Guyatt GH, American College of Chest Physicians

Institution

Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada. batesm@mcmaster.ca

Source

Chest 141:2 Suppl 2012 Feb pg e351S-418S

MeSH

Adult
Ambulatory Care
Evidence-Based Medicine
Female
Fibrin Fibrinogen Degradation Products
Fibrinolytic Agents
Hemorrhage
Humans
Magnetic Resonance Angiography
Male
Phlebography
Predictive Value of Tests
Probability
Pulmonary Embolism
Risk Factors
Societies, Medical
Thrombosis
Tomography, X-Ray Computed
Ultrasonography
United States
Venous Thrombosis

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

22315267