Current standings in diagnostic management of acute venous thromboembolism: Still rough around the edges

Blood Rev. 2016 Jan;30(1):21-6. doi: 10.1016/j.blre.2015.07.002. Epub 2015 Jul 16.

Abstract

Signs and symptoms of acute deep vein thrombosis (DVT) and pulmonary embolism (PE) are notoriously non-specific. Therefore, diagnostic management algorithms have been developed, consisting of a clinical decision rule (CDR), D-dimer testing and an imaging test, that allow safe diagnostic management and the exclusion of VTE in clinical practice. However, several challenges still remain: adherence to the diagnostic algorithms, accurate diagnosis of recurrent VTE and reducing the radiation exposure associated with computed tomography pulmonary angiography for suspected PE. In this clinically oriented review, we will provide an overview of current diagnostic algorithms for suspected DVT and PE and focus on recent advances including strategies to improve adherence to recommended algorithms, age-dependent D-dimer threshold and novel imaging techniques.

Keywords: Decision support techniques; Diagnosis; Diagnostic imaging; Fibrin fibrinogen degradation products; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Clinical Decision-Making
  • Decision Support Techniques*
  • Diagnostic Imaging / instrumentation
  • Diagnostic Imaging / methods*
  • Disease Management
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fibrinogen / metabolism
  • Humans
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / diagnostic imaging
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis*
  • Venous Thromboembolism / diagnostic imaging
  • Venous Thrombosis / blood
  • Venous Thrombosis / diagnosis*
  • Venous Thrombosis / diagnostic imaging

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Fibrinogen