Cost-effective Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism
Arnaud Perrier (1) , Henri Bounameaux (2)
(1) Medical Clinics 1 and 2, (2) Division of Angiology and Haemostasis, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
Summary Suspected acute venous thromboembolism is a frequent and challengingclinical problem. Phlebography and pulmonary angiography arecostly and invasive and, hence, ill-suited for diagnosing a diseasepresent in only 20% of patients in whom it is suspected. Novel non-invasiveinstruments, such as plasma D-dimer measurement, lowerlimb compression ultrasonography and helical CT scan are importantbreakthroughs in the management of patients with suspected venousthromboembolism. However, none of these instruments is ideal, andthey must be combined in rational and cost-effective diagnostic algorithmsincluding clinical assessment, which is increasingly standardized.Such strategies must be validated in management studies, in whichpatients without venous thromboembolism are not treated and followedup during 3 months. Suspected massive pulmonary embolism is adistinct clinical situation requiring a specific diagnostic approach, inwhich echocardiography plays a major role. This paper reviews theperformance of clinical evaluation and diagnostic tests for venousthromboembolism, and recently validated diagnostic schemes.