Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease
Publication Date: May 1, 2018
Last Updated: March 14, 2022
Recommendations
For patients who are at low risk for acute PE, use the Pulmonary Embolism Rule-out Criteria (PERC) to exclude the diagnosis without further diagnostic testing. (B)
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In patients older than 50 years deemed to be low or intermediate risk for acute PE, clinicians may use a negative age-adjusted D-dimer* result to exclude the diagnosis of PE. *For highly sensitive D-dimer assays using fibrin equivalent units (FEU) use a cutoff of age×10 μg/L; for highly sensitive D-dimer assays using D-dimer units (DDU), use a cutoff of age×5 μg/L. (B)
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Given the lack of evidence, anticoagulation treatment decisions for patients with subsegmental PE without associated deep venous thrombosis (DVT) should be guided by individual patient risk profiles and preferences. (C)
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Selected patients with acute PE who are at low risk for adverse outcomes as determined by Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), or the Hestia criteria may be safely discharged from the ED on anticoagulation, with close outpatient follow-up. (C)
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In selected patients diagnosed with acute DVT, a NOAC may be used as a safe and effective treatment alternative to low-molecular-weight heparin (LMWH) and vitamin K antagonist (VKA). (B)
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Selected patients with acute DVT may be safely treated with a Non–Vitamin K Antagonist Oral Anticoagulant (NOAC) and directly discharged from the ED. (C)
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Title
Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
May 1, 2018
Last Updated Month/Year
August 7, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult patients with suspected venous thromboembolism.
Target Patient Population
Patients with suspected venous thromboembolism
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Emergency care
Intended Users
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D054556 - Venous Thromboembolism, D000925 - Anticoagulants, D013923 - Thromboembolism
Keywords
anticoagulation, Venous Thromboembolism, management of venous thromboembolism, venous thromboembolic event (VTE), Anticoagulation
Source Citation
Ann Emerg Med. 2018;71:e59-e109
Methodology
Number of Source Documents
103
Literature Search Start Date
January 1, 2006
Literature Search End Date
April 22, 2016