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.|
|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.