Diagnosis and management of venous thromboembolism: Results of a survey on current clinical practice.
BACKGROUND
The implementation of evidence from clinical studies into daily clinical practice is not a straightforward process. We developed a standardized questionnaire to explore clinical practice patterns in the management of VTE, in particular about the use of pre-clinical probability and D-dimer testing and on the home treatment of pulmonary embolism (PE).


METHODS
The standardized questionnaire was sent to all 394 physician members of the Italian Society of Thrombosis and Haemostasis (SISET) by e-mail. The questionnaire contained three groups of questions: about general information, about the diagnostic process for both deep venous thrombosis (DVT) and PE, and about home-therapy of PE.


RESULTS
One hundred and twenty-eight (32.5%) physicians responded the questionnaire. For DVT diagnosis 69 (54.3%) physicians answered that they always use the D-dimer test; 4 (3.1%) do never use it; whereas only 11 (8.7%) take notice of the D-dimer result before visiting the patients; 38 (29.9%) use only clinical judgment to assess pre-clinical probability of disease. For the diagnosis of PE 80 (66.1%) physicians always use the D-dimer test, whereas 3 (2.5%) do never use it; whereas 14 (11.7%) take notice of the D-dimer result before visiting the patients; 50 (41.3%) use only clinical judgment to assess pre-clinical probability. Sixty-six (59.5%) clinicians declared to treat patients with PE at home, when feasible.


CONCLUSIONS
The diagnostic approach to VTE among expert physicians appears to be heterogeneous; in particular there is no widespread use of clinical prediction rules. The majority of expert physicians appear to consider the possibility of treating at home patients with PE.
Squizzato
Alessandro
A
Department of Clinical Medicine, University of Insubria, Varese, Italy. alexsquizzo@libero.it
Micieli
Evy
E
Galli
Matteo
M
Gibson
Nadine
N
Gerdes
Victor E A
VE
Dentali
Francesco
F
Buller
Harry
H
Ageno
Walter
W
Venco
Achille
A
D003625:Data Collection; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis / Q000378:metabolism; D006801:Humans; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011336:Probability; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards; D054556:Venous Thromboembolism / Q000175:diagnosis*
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D