Risk Assessment in Venous ThromboEmbolism

Abstract

Clinical pre-test probability scores are used to guide the subsequent steps in the diagnosis and therapy of venous thromboembolism. However, often there is resistance in accepting formal and standardized procedures as a substitute of expert judgements. A review of the available tools as well as of the laboratory and imaging techniques is presented, together with the detailed report of a comprehensive debate held on the Vasculab Mailing List. Several unusual topics came to attention during the discussion: as the validation of scores, limited to a few contexts and populations; the over-utilization of venous duplex ultrasound and the rational use of resources; how to choose the steps, managing the amount of time waiting for the results of a test; the scarce attention given today to the long term complications, like the chronic pulmonary embolism, the pulmonary hypertension and the postthrombotic syndrome. A lot of open problems of course remains, the report being witness of the value of a free style atypical discussion, as generally occurs on Vasculab.Keywords Venous thromboembolism, pre-test probability scores, duplex ultrasound, D-Dimer, sPselectin, chronic thromboembolic pulmonary hypertension.