title: Clinical decision rules and D-Dimer in venous thromboembolism: current controversies and future research priorities.
abstract: Venous thromboembolism (VTE) is a potentially lethal clinical condition that is suspected in patients with common clinical complaints, in many and varied, clinical care settings. Once VTE is diagnosed, optimal therapeutic management (thrombolysis, IVC filters, type and duration of anticoagulants) and ideal therapeutic management settings (outpatient, critical care) are also controversial. Clinical prediction tools, including clinical decision rules and D-Dimer, have been developed, and some validated, to assist clinical decision making along the diagnostic and therapeutic management paths for VTE. Despite these developments, practice variation is high and there remain many controversies in the use of the clinical prediction tools. In this narrative review, we highlight challenges and controversies in VTE diagnostic and therapeutic management with a focus on clinical decision rules and D-Dimer.
authors.affiliation: Hematology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Obstetrics and Gynaecology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada. Electronic address: mrodger@ohri.ca.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Rodger
authors.affiliation: Hematology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Obstetrics and Gynaecology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Le Gal
authors.affiliation: Hematology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Obstetrics and Gynaecology, University of Ottawa and The Ottawa Hospital, Ottawa, ON Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Wells
authors.affiliation: Cambridge Haemophilia and Thrombophilia Centre, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Trevor
authors.initials: T
authors.lastname: Baglin
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Division of Angiology and Hemostasis, Department of Medical Specialties, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: Unit of Angiology and Blood Coagulation, University Hospital of Bologna, Italy.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.affiliation: Department of Thrombosis and Hemostasis, LUMC, Leiden, the Netherlands.
authors.forename: Menno
authors.initials: M
authors.lastname: Huisman
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité and Hopital europeen Georges Pompidou APHP, Paris, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020000:Decision Support Systems, Clinical; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000628:therapy; D012106:Research; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Clinical Decision Rules; D-dimer; Diagnosis; Prognosis; Treatment; Venous Thromboembolism