Journal de recherche clinique

Deep Vein Thrombosis in Emergency Department: A Simplified Systematic Approach

Abstract

Cinzia Nitti, Francesca Riccomi, Lucia Salvi, Susanna Contucci and Aldo Salvi

Management of patients with Deep Vein Thrombosis (DVT) in the Emergency Department (ED) has dramatically changed over the last 10 years in the absence of a shared management, leading to the need of a shared consensus strategy to standardize the diagnostic and therapeutic approach in acute phase of DVT in a setting where standardization is particularly difficult due to the volume of activity and the number of operators who alternate in the care of the individual patient. We perform a review and comment of a NGT work performed by a panel of 5 Italian experts who developed 21 consensus statements based on available evidence and their clinical experience. Considering the best available evidence and the longstanding clinical experience of 5 Italian EDs’ experts, the management of patients with suspected DVT to ED should be characterized by a standardized diagnostic process, guided by the estimation of pre-test clinical probability with formal and validated Clinical Prediction Rule (CPR), an increase in the number of patients discharged directly from the ED, reserving hospitalization only for high-risk patients and faster and more appropriate use of the wide range of anticoagulant drugs currently available. In conclusion such a guide will standardize the diagnostic and therapeutic approach in acute phase of DVT, limit the number of diagnostic tests performed to exclude or confirm DVT and shorten the stay time of these patients in ED without reducing safety. Indeed, the identification of simple criteria for the definition of high-risk DVT together with availability of DOACs will allow physicians to safely discharge all DVT patients who do not meet these risk criteria, directly from the emergency room.