Diagnosis
Suspected First LE DVT: Low Pretest Probability Figure 1. Suspected First LE DVT - Low PTP Low PTP
Preferred
High/Mod sensitive D-dimer –
+ No DVT ÎUse one of the following initial tests:
• A moderately sensitive D-dimer OR • A highly sensitive D-dimer OR • Compression ultrasound (CUS) of the proximal veins, rather than ▶ no diagnostic testing (1-B for all comparisons) or ▶ venography (1-B for all comparisons) or ▶ whole-leg US (2-B for all comparisons).
ÎInitial use of a moderately sensitive (2-C) or highly sensitive (2-B) D-dimer is preferred over proximal CUS.
The choice between a moderately sensitive D-dimer test, a highly sensitive D-dimer test, or proximal CUS as the initial test will depend on local availability, access to testing, costs of testing, and the probability of obtaining a negative D-dimer result if DVT is not present.
ÎIf the D-dimer is negative, no further testing is preferred over further investigation with proximal CUS or whole-leg US or venography (1-B for all comparisons).
ÎIf the D-dimer is positive, further testing with CUS of the proximal veins is preferred over whole-leg US (2-C) or venography (1-B).
ÎIf the proximal CUS is negative, no further testing is preferred over repeat proximal CUS after 1 week or whole-leg US or venography (1-B for all comparisons).
ÎIf CUS of the proximal veins is positive, treat for DVT without confirmatory venography (2-C).
In circumstances where high-quality venography is available, patients who are not averse to the discomfort of venography, are less concerned about the complications of venography, and place a high value on avoiding treatment of false-positive results are likely to choose confirmatory venography if findings for DVT are less certain (eg, a short segment of venous noncompressibility).
1
Proximal CUS +
– Treat No DVT
