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New Guidelines for Diagnosis of Venous Thromboembolism

AAFP and ACP have released new clinical practice guidelines for diagnosis and management of venous thromboembolism.//

Venous thromboembolism is a condition that causes clotting in the veins.

Key elements of the diagnosis guideline include the use of clinical prediction rules to establish pretest probability of deep vein thrombosis or pulmonary embolism in a patient before further testing and the utility of various diagnostic tools such as D-dimer and ultrasonography.

The management guideline supports the use of low-molecular weight heparin for patients with deep vein thrombosis in the outpatient setting when appropriate support services are in place. Each guideline contains several recommendations to aid in the diagnosis and treatment of lower extremity deep venous thrombosis and pulmonary embolism.

A thromboembolism occurs when a blood clot, formed at one point in the circulatory system, detaches and obstructs circulation at another point. A pulmonary embolism occurs when such a clot, usually originating in the veins of the leg, obstructs the pulmonary artery or one of its branches. A large embolus may result in acute heart failure or sudden death. More than 200,000 deaths each year are associated with VTE in the United States.

The Annals of Family Medicine and Annals of Internal Medicine have joined in publishing the new guidelines. Both guidelines and an evidence review for the diagnosis guideline are published in this issue of Annals of Family Medicine. The management guideline is being published at www.annals.org on Monday, Jan. 29, at 6 p.m. EST. The management guideline and companion evidence review will be published in the Feb. 6, 2007, issue of Annals of Internal Medicine.

The new diagnosis guideline targets primary care physicians who are most likely to have frontline contact with patients who have not yet been diagnosed. The guideline aims to present evidence-based recommendations for diagnosis of lower extremity DVT and pulmonary embolism.

"These new guidelines represent a collaborative effort between family medicine and internal medicine," said Rick Kellerman, M.D., The American Academy of Family Physicians (AAFP) president. "We are pleased to collaborate with the American College of Physicians on this endeavor to provide physicians with the tools they need to prevent mortality and morbidity associated with venous thromboembolism."

Incidence rates for VTE are higher in men, African-Americans, and increase substantially with age. Treating VTE at an early stage can avoid complications such as pulmonary embolism or recurrent DVT.

" American College of Physicians (ACP) has been producing evidence-based clinical practice guidelines since 1981 to help physicians provide the best health care possible, based on the best available current evidence," said Amir Qaseem, MD, PhD, MHA, senior medical associate in the Clinical Programs and Quality of Care department of the Medical Education and Publishing Division at the American College of Physicians. "These guidelines provide information on the utility of various diagnostic tools and compare the efficacy and safety of various pharmacologic agents used for treatment of VTE."



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