Diagnóstico de Trombose Venosa Profunda

Segue o link com os principais critérios diagnósticos clínicos e exames complementares para o diagnósticos de TVP :

http://web.b.ebscohost.com/dynamed/detail?sid=ed2a80b8-00c3-4023-9b63-d075d979a30a%40sessionmgr110&vid=2&expand=Diagnosis&hid=107&bdata=Jmxhbmc9cHQtYnImc2l0ZT1keW5hbWVkLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=dme&AN=133588&anchor=Diagnosis





Making the diagnosis:
validated clinical prediction rule recommended to estimate pretest probability of venous thromboembolism(1, 2, 3)
in patient with low clinical pretest probability of DVT
suggested initial test is highly sensitive D-dimer (ACCP Grade 2B)(6)
negative high-sensitivity D-dimer can rule out DVT (ACCP Grade 1B)(2, 3, 6)
D-dimer may not be sufficient to rule out DVT in older patients or patients with comorbidity or long duration of symptoms(3)
if positive D-dimer, consider lower extremity duplex ultrasound with compression of proximal veins (ACCP Grade 2B)(2, 3, 6)
in patient with moderate clinical pretest probability of DVT
guidelines for suggested initial test vary - either highly sensitive D-dimer (ACCP Grade 2C)(6) or compression ultrasound(2, 3)
if highly sensitive D-dimer used, negative test can rule out DVT (ACCP Grade 1B) and positive test should lead to proximal compression ultrasound (ACCP Grade 1B)(6)
if ultrasound used, positive ultrasound is diagnostic and negative ultrasound should lead to highly sensitive D-dimer testing(2, 3)
in patient with high clinical pretest probability of DVT(6)
recommended initial test is proximal compression ultrasound or whole-leg ultrasound (ACCP Grade 1B)
positive ultrasound confirms presence of DVT (ACCP Grade 1B)
if negative proximal compression ultrasound further testing recommended with any of (ACCP Grade 1B)
highly sensitive D-dimer (no further testing if negative [ACCP Grade 1B])
whole-leg ultrasound (no further testing if negative [ACCP Grade 2B])
repeat proximal compression ultrasound in 1 week (no further testing if negative [ACCP Grade 1B])
if clinical suspicion for pulmonary embolism (PE)
patients with intermediate or high pretest probability of PE require diagnostic imaging studies(3)
patients with high clinical pretest probability of PE should start anticoagulation without delay (ACCP Grade 2C)(2)