title: Current standings in diagnostic management of acute venous thromboembolism: Still rough around the edges.
abstract: Signs and symptoms of acute deep vein thrombosis (DVT) and pulmonary embolism (PE) are notoriously non-specific. Therefore, diagnostic management algorithms have been developed, consisting of a clinical decision rule (CDR), D-dimer testing and an imaging test, that allow safe diagnostic management and the exclusion of VTE in clinical practice. However, several challenges still remain: adherence to the diagnostic algorithms, accurate diagnosis of recurrent VTE and reducing the radiation exposure associated with computed tomography pulmonary angiography for suspected PE. In this clinically oriented review, we will provide an overview of current diagnostic algorithms for suspected DVT and PE and focus on recent advances including strategies to improve adherence to recommended algorithms, age-dependent D-dimer threshold and novel imaging techniques.
authors.affiliation: Department of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands. Electronic address: t.van_der_hulle@lumc.nl.
authors.forename: T
authors.initials: T
authors.lastname: van der Hulle
authors.affiliation: Department of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.
authors.forename: C E A
authors.initials: CE
authors.lastname: Dronkers
authors.affiliation: Department of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Department of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.
authors.forename: F A
authors.initials: FA
authors.lastname: Klok
mesh_terms: D000208:Acute Disease; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000295:instrumentation / Q000379:methods*; D019468:Disease Management; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: Decision support techniques; Diagnosis; Diagnostic imaging; Fibrin fibrinogen degradation products; Venous thromboembolism