ÎEvaluate initially with proximal CUS rather than other initial tests, including a whole-leg US (2-C), moderately sensitive D-dimer (2-C), highly sensitive D-dimer (1-B), or venography (1-B).
ÎIf initial proximal CUS is negative, further testing should be with either serial proximal CUS (day 3 and day 7) (1-B) or a sensitive D-dimer done at the time of presentation (Grade 2-B) rather than no further testing for DVT.
ÎPatients with an initial negative proximal CUS and a subsequent negative sensitive D-dimer or negative serial proximal CUS should NOT undergo further testing for DVT (1-B), and patients with positive D-dimer should have an additional follow-up proximal CUS (day 3 and day 7) rather than venography (1-B) or whole-leg US (2-C).
ÎIn pregnant patients with symptoms suggestive of isolated iliac vein thrombosis (swelling of the entire leg, with or without flank, buttock, or back pain) and no evidence of DVT on standard proximal CUS, further testing with either Doppler US of the iliac vein (2-C), venography (2-C), or direct MRI (2-C), is preferred over standard serial CUS of the proximal deep veins.
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