Principles of venous thromboembolism diagnosis

Abstract

Making a diagnosis of venous thromboembolism (VTE), manifesting as deep vein thrombosis (DVT) and/or pulmonary embolism (PE) requires clinical assessment, as well as imaging and - in selected clinical settings - laboratory tests. The clinical assessment utilizes validated clinical scoring models of DVT and/or PE probability, designed to stratify patients into higheror lower-risk groups of VTE development. When the clinical probability is high the imaging studies must be performed and if their results are positive, the VTE diagnosis is confirmed. When the clinical probability is low, instead of imaging studies D-dimer test should be used and if negative the VTE can be ruled out. When the clinical assessment is discordant with the results of imaging and lab testing, including high clinical probability and normal imaging studies or low clinical risk but positive D-dimer and normal imaging tests, serial imaging studies is required to confirm or refute a diagnosis of VTE. As compared with the first episode of VTE, establishing or refuting a diagnosis of recurrent VTE is usually more difficult.