Clinical Practice Guidelines
(Jointly Developed, March 2006)
(Reaffirmed, December 2014)
The guideline, Current Diagnosis of Venous Thromboembolism in Primary Care: A Clinical Guideline, was developed by the American Academy of Family Physicians and the American College of Physicians.
- Validated clinical prediction rules should be used to estimate pretest probability of venous thromboembolism (VTE), both deep venous thrombosis (DVT) and pulmonary embolism, and for the basis of interpretation of subsequent tests.
- In appropriately selected patients with low pretest probability of DVT or pulmonary embolism, obtaining a high-sensitivity D-dimer is a reasonable option, and if negative, indicates a low likelihood of VTE.
- Ultrasound is recommended for patients with intermediate to high pretest probability of DVT in the lower extremities.
- Patients with intermediate or high pretest probability of pulmonary embolism require diagnostic imaging studies, such as ventilation-perfusion (V/Q) scan, multidetector helical computed axial tomography (CT), or pulmonary angiography.
See the full recommendation for further details, including the Wells Predictor Rules.
(Endorsed With Qualifications, June 2013)
The guideline, Venous Thromboembolism Prophylaxis in Hospitalized Patients, was developed by the American College of Physicians, and endorsed with qualifications by the American Academy of Family Physicians.
- Medical (including stroke) patients should be assessed for risk for thromboembolism and bleeding prior to initiation of prophylaxis of venous thromboembolism.
- Medical (including stroke) patients should receive pharmacologic prophylaxis with heparin or a related drug for venous thromboembolism unless the assessed risk for bleeding outweighs the likely benefits.
- Graduated compression stockings should not be used for prevention of venous thromboembolism.
- There are three recommendations in the guideline and all three are upgraded based on lower-level evidence.
- Reviewers were concerned that for the first recommendation an assessment tool is needed and one is not provided.
See full recommendation for further details.
These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.