| Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | |
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MedLine Citation:
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PMID: 22315267 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Objective testing for DVT is crucial because clinical assessment alone is unreliable and the consequences of misdiagnosis are serious. This guideline focuses on the identification of optimal strategies for the diagnosis of DVT in ambulatory adults. METHODS: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. RESULTS: We suggest that clinical assessment of pretest probability of DVT, rather than performing the same tests in all patients, should guide the diagnostic process for a first lower extremity DVT (Grade 2B). In patients with a low pretest probability of first lower extremity DVT, we recommend initial testing with D-dimer or ultrasound (US) of the proximal veins over no diagnostic testing (Grade 1B), venography (Grade 1B), or whole-leg US (Grade 2B). In patients with moderate pretest probability, we recommend initial testing with a highly sensitive D-dimer, proximal compression US, or whole-leg US rather than no testing (Grade 1B) or venography (Grade 1B). In patients with a high pretest probability, we recommend proximal compression or whole-leg US over no testing (Grade 1B) or venography (Grade 1B). CONCLUSIONS: Favored strategies for diagnosis of first DVT combine use of pretest probability assessment, D-dimer, and US. There is lower-quality evidence available to guide diagnosis of recurrent DVT, upper extremity DVT, and DVT during pregnancy. |
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Authors:
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Shannon M Bates; Roman Jaeschke; Scott M Stevens; Steven Goodacre; Philip S Wells; Matthew D Stevenson; Clive Kearon; Holger J Schunemann; Mark Crowther; Stephen G Pauker; Regina Makdissi; Gordon H Guyatt; |
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Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Chest Volume: 141 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-08 Completed Date: 2012-04-13 Revised Date: 2013-05-20 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: e351S-418S Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada. batesm@mcmaster.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Ambulatory Care Evidence-Based Medicine* Female Fibrin Fibrinogen Degradation Products / analysis Fibrinolytic Agents / adverse effects, therapeutic use* Hemorrhage / blood, chemically induced, prevention & control Humans Magnetic Resonance Angiography / methods Male Phlebography / methods Predictive Value of Tests Probability Pulmonary Embolism / diagnosis, drug therapy, prevention & control Risk Factors Societies, Medical* Thrombosis / diagnosis*, drug therapy*, prevention & control Tomography, X-Ray Computed / methods Ultrasonography / methods United States Venous Thrombosis / diagnosis*, drug therapy*, prevention & control |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 0/Fibrinolytic Agents; 0/fibrin fragment D |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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