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.

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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 Academy of Family Physicians
American College of Physicians
American College of Emergency Physicians guidelines

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.