American Society of Hematology 2018 guidelines for management of venous thromboembolism

diagnosis of venous thromboembolism

Wendy Lim, Grégoire Le Gal, Shannon M. Bates, Marc Righini, Linda B. Haramati, Eddy Lang, Jeffrey Kline, Sonja Chasteen, Marcia Snyder, Payal Patel, Meha Bhatt, Parth Patel, Cody Braun, Housne Begum, Wojtek Wiercioch, Holger J. Schünemann, Reem A. Mustafa

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

BACKGROUND: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

Original languageEnglish (US)
Pages (from-to)3226-3256
Number of pages31
JournalBlood advances
Volume2
Issue number22
DOIs
StatePublished - Nov 27 2018

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Venous Thromboembolism
Guidelines
Upper Extremity Deep Vein Thrombosis
Pulmonary Embolism
Venous Thrombosis
Lower Extremity
Patient Advocacy
Diagnostic Imaging
Routine Diagnostic Tests
Ultrasonography
Patient Care
Perfusion
Delivery of Health Care
Lung

Cite this

Lim, W., Le Gal, G., Bates, S. M., Righini, M., Haramati, L. B., Lang, E., ... Mustafa, R. A. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood advances, 2(22), 3226-3256. https://doi.org/10.1182/bloodadvances.2018024828

American Society of Hematology 2018 guidelines for management of venous thromboembolism : diagnosis of venous thromboembolism. / Lim, Wendy; Le Gal, Grégoire; Bates, Shannon M.; Righini, Marc; Haramati, Linda B.; Lang, Eddy; Kline, Jeffrey; Chasteen, Sonja; Snyder, Marcia; Patel, Payal; Bhatt, Meha; Patel, Parth; Braun, Cody; Begum, Housne; Wiercioch, Wojtek; Schünemann, Holger J.; Mustafa, Reem A.

In: Blood advances, Vol. 2, No. 22, 27.11.2018, p. 3226-3256.

Research output: Contribution to journalReview article

Lim, W, Le Gal, G, Bates, SM, Righini, M, Haramati, LB, Lang, E, Kline, J, Chasteen, S, Snyder, M, Patel, P, Bhatt, M, Patel, P, Braun, C, Begum, H, Wiercioch, W, Schünemann, HJ & Mustafa, RA 2018, 'American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism', Blood advances, vol. 2, no. 22, pp. 3226-3256. https://doi.org/10.1182/bloodadvances.2018024828
Lim, Wendy ; Le Gal, Grégoire ; Bates, Shannon M. ; Righini, Marc ; Haramati, Linda B. ; Lang, Eddy ; Kline, Jeffrey ; Chasteen, Sonja ; Snyder, Marcia ; Patel, Payal ; Bhatt, Meha ; Patel, Parth ; Braun, Cody ; Begum, Housne ; Wiercioch, Wojtek ; Schünemann, Holger J. ; Mustafa, Reem A. / American Society of Hematology 2018 guidelines for management of venous thromboembolism : diagnosis of venous thromboembolism. In: Blood advances. 2018 ; Vol. 2, No. 22. pp. 3226-3256.
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abstract = "BACKGROUND: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.",
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T1 - American Society of Hematology 2018 guidelines for management of venous thromboembolism

T2 - diagnosis of venous thromboembolism

AU - Lim, Wendy

AU - Le Gal, Grégoire

AU - Bates, Shannon M.

AU - Righini, Marc

AU - Haramati, Linda B.

AU - Lang, Eddy

AU - Kline, Jeffrey

AU - Chasteen, Sonja

AU - Snyder, Marcia

AU - Patel, Payal

AU - Bhatt, Meha

AU - Patel, Parth

AU - Braun, Cody

AU - Begum, Housne

AU - Wiercioch, Wojtek

AU - Schünemann, Holger J.

AU - Mustafa, Reem A.

PY - 2018/11/27

Y1 - 2018/11/27

N2 - BACKGROUND: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

AB - BACKGROUND: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics. OBJECTIVE: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE. METHODS: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations. RESULTS: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT. CONCLUSIONS: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.

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