Choosing Wisely:

In patients with a low pretest probability of venous thrombo-embolism, obtain a high-sensitive D-dimer measurement as the initial diagnostic test; don’t obtain imaging studies as the initial diagnostic test.

Rationale and Comments: In patients with low pretest probability of venous thromboembolism as defined by the Wells prediction rules, a negative high-sensitivity D-dimer measurement effectively excludes venous thromboembolism and the need for further imaging studies.
Sponsoring Organizations:
  • American College of Physicians
  • Sources:
  • American College of Physicians
  • American College of Emergency Physicians guidelines
  • American Academy of Family Physicians
  • Disciplines:
  • Pulmonary medicine
  • References: • American College of Emergency Physicians. Evaluation and management of adult emergency department patients with suspected pulmonary embolism. January 2011. http://www.acep.org/Content.aspx?id=80332.
    • 2008 European Society of Cardiology. Acute pulmonary embolism (diagnosis and management of). 2008. http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/acute-pulmonary-embolism.aspx.
    • Snow V, et al. Management of venous thromboembolism. Ann Intern Med. 2007;146:204-10.
    • Scottish Intercollegiate Guidelines Network. Prevention and management of venous thromboembolism.
    http://www.sign.ac.uk/guidelines/fulltext/122/index.html.

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