Diagnosis of Deep-Vein Thrombosis and Pulmonary Embolism: The New Guideline of the Dutch Institute for Health Care Improvement

Reliable diagnosis of venous thrombosis or pulmonary embolism is crucial, as especially pulmonary embolism is a potentially fatal disorder. Recently the guideline of the Dutch institute for health care improvement (CBO), ‘diagnosis, prevention and treatment of venous thromboembolism (VTE) and secondary prevention of arterial thrombosis’ was published. The diagnostic algorithm in case of suspected VTE starts with a clinical decision rule according to Wells followed by a d-dimer test. These simple, non-invasive and cheap tests, exclude VTE in 25–30% of the patients with a suspected episode of VTE. With a dichotomized clinical decision rule, a ‘likely’ Wells score or an abnormal d-dimer concentration necessitates additional testing, like ultrasonography of the leg veins when deep-vein thrombosis is suspected, or multidetector computerized tomographic scanning in the case of suspected pulmonary embolism. These diagnostic algorithms considerably simplify the diagnosis of VTE.