TUESDAY, Jan. 30 (HealthDay News) -- The American Academy of Family Physicians and the American College of Physicians have issued new guidelines for the diagnosis and treatment of lower extremity deep venous thrombosis (DVT) and pulmonary embolism, based on evidence-based reviews. The guidelines are published in the January/February issue of the Annals of Family Medicine.
The evidence was reviewed by a team led by Jodi Segal, M.D., of Johns Hopkins University. Amir Qaseem, M.D., Ph.D., of the American College of Physicians, and colleagues developed recommendations for the diagnosis of DVT and pulmonary embolism. They recommend using good clinical prediction tools such as the Wells prediction rule to determine the probability of disease, high-sensitivity D-dimer testing as a negative predictor in patients with a low probability of disease, and ultrasound and imaging studies for patients with intermediate to high disease probability.
The recommendations for management were developed by Vincenza Snow, M.D., of the American College of Physicians in Philadelphia, and colleagues. They recommend that low molecular weight heparin be initially used to treat DVT, while both low molecular weight and unfractionated heparin can be used to treat pulmonary embolism. Some patients with DVT and possibly pulmonary embolism can be safely and cost-effectively treated with low molecular weight heparin on an outpatient basis, they note.
"The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed," write Qaseem and colleagues. "This field is highly dynamic, however, and new evidence is emerging periodically that may change the recommendations."
Abstract - Qaseem
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Abstract - Segal
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Abstract - Snow
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