Division of Hematology, Department of Medicine, University of Ottawa and the Ottawa Health Research Institute, Ottawa, Parkdale Clinic, Ottawa, Ontario, Canada.
Semin Thromb Hemost. 2012 Oct;38(7):691-701. doi: 10.1055/s-0032-1327770. Epub 2012 Oct 3.
Venous thromboembolism (VTE) is a serious and potentially fatal medical condition. Correct diagnosis and early treatment of VTE with anticoagulant drugs are critical steps in preventing further complications and recurrence. Evidence suggests that patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE) should be managed with a diagnostic strategy that includes clinical pretest probability assessment, D-dimer test, and imaging. Clinical probability scoring, complemented by selective D-dimer testing, has become the recommended strategy for diagnosis. The reason is that overwhelming evidence suggests that patients with suspected VTE are better managed with a diagnostic strategy. If diagnostic algorithms are followed correctly, the chances of adverse events are extremely low (< 1%) in patients in whom VTE has been ruled out, whereas incomplete strategies leads to an increased risk of recurrent VTE or death. This review focuses on the application of diagnostic strategies with suspected DVT or PE into daily clinical practice while discussing the benefits and disadvantages of different approaches.
静脉血栓栓塞症（VTE）是一种严重且可能致命的医疗状况。正确诊断和早期使用抗凝药物治疗 VTE 是预防进一步并发症和复发的关键步骤。有证据表明，疑似深静脉血栓形成（DVT）或肺栓塞（PE）的患者应采用包括临床前期概率评估、D-二聚体检测和影像学检查的诊断策略进行管理。临床概率评分，辅以选择性 D-二聚体检测，已成为推荐的诊断策略。原因是压倒性的证据表明，疑似 VTE 的患者最好采用诊断策略进行管理。如果正确遵循诊断算法，在已排除 VTE 的患者中，不良事件的可能性极低（<1%），而不完整的策略会导致复发性 VTE 或死亡的风险增加。本文重点讨论了在日常临床实践中应用疑似 DVT 或 PE 的诊断策略，同时讨论了不同方法的优缺点。
