venous thromboembolic diseases: the management of venous ...inte venous thromboembolic diseases...

Download Venous thromboembolic diseases: the management of venous ...inte Venous thromboembolic diseases Venous

If you can't read please download the document

Post on 25-May-2020

2 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • 1

    Venous thromboembolic diseases

    Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing

    Clinical Guideline

    Methods, evidence and recommendations

    June 2012

    Commissioned by the National Institute for Health and Clinical Excellence

  • Venous thromboembolic diseases

    Venous thromboembolic diseases

    Published by the National Clinical Guideline Centre at The Royal College of Physicians, 11 St Andrews Place, Regents Park, London, NW1 4BT

    First published June 2012

    © National Clinical Guideline Centre - June 2012

    Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

    The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

    The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

  • Venous thromboembolic diseases Page 4 of 245

    Contents Guideline development group members ....................................................................................... 8

    Acknowledgments ....................................................................................................................... 9

    Abbreviations ............................................................................................................................. 10

    1 Introduction ........................................................................................................................ 12

    2 Development of the guideline .............................................................................................. 14

    2.1 What is a NICE clinical guideline? ....................................................................................... 14

    2.2 Remit ................................................................................................................................... 14

    2.3 Who developed this guideline? .......................................................................................... 15

    2.4 What this guideline covers .................................................................................................. 15

    2.5 What this guideline does not cover .................................................................................... 15

    2.6 Relationships between the guideline and other NICE guidance ......................................... 16

    3 Methods .............................................................................................................................. 17

    3.1 Developing the review questions and outcomes ................................................................ 17

    3.2 Searching for evidence ........................................................................................................ 20

    3.2.1 Clinical literature search ...................................................................................... 20

    3.2.2 Health economic literature search ...................................................................... 20

    3.3 Evidence of effectiveness .................................................................................................... 21

    3.3.1 Inclusion/exclusion .............................................................................................. 21

    3.3.2 Methods of combining clinical studies ................................................................ 22

    3.3.3 Appraising the quality of evidence by outcomes ................................................ 23

    3.3.4 Grading the quality of clinical evidence............................................................... 25

    3.3.5 Study limitations .................................................................................................. 25

    3.3.6 Inconsistency ....................................................................................................... 26

    3.3.7 Indirectness ......................................................................................................... 26

    3.3.8 Imprecision .......................................................................................................... 27

    3.4 Evidence of cost-effectiveness ............................................................................................ 28

    3.4.1 Literature review ................................................................................................. 28

    3.4.2 Undertaking new health economic analysis ........................................................ 30

    3.4.3 Cost-effectiveness criteria ................................................................................... 31

    3.5 Developing recommendations ............................................................................................ 31

    3.5.1 Research recommendations ................................................................................ 32

    3.5.2 Validation process ............................................................................................... 32

    3.5.3 Updating the guideline ........................................................................................ 32

    3.5.4 Disclaimer ............................................................................................................ 32

    3.5.5 Funding ................................................................................................................ 32

    4 Guideline summary .............................................................................................................. 33

  • Venous thromboembolic diseases Page 5 of 245

    4.1 Algorithms ........................................................................................................................... 33

    4.2 Key priorities for implementation ....................................................................................... 35

    4.3 Full list of recommendations .............................................................................................. 37

    4.4 Key research recommendations ......................................................................................... 41

    5 Diagnosis of deep vein thrombosis ....................................................................................... 42

    5.1 Introduction ........................................................................................................................ 42

    5.2 Clinical probability scores (clinical scores) .......................................................................... 42

    5.2.1 In people with suspected DVT, what is the effectiveness of clinical probability scores in ruling out DVT? .................................................................. 43

    5.3 D-dimer ............................................................................................................................... 44

    5.3.1 In people with suspected DVT, what is the effectiveness of D-dimer in ruling out DVT? .............................................................................................................. 45

    5.4 Ultrasound........................................................................................................................... 47

    5.4.1 In people with suspected DVT, what is the effectiveness of ultrasound in ruling out DVT? .................................................................................................... 48

    5.5 Recommendations and link to evidence ............................................................................. 54

    5.6 Summary of research recommendations ............................................................................ 67

    6 Diagnosis of pulmonary embolism ........................................................................................ 68

    6.1 Introduction ........................................................................................................................ 68

    6.2 Clinical probability scores and D-dimers ............................................................................. 68

    6.2.1 In people with suspected PE, can we safely rule out further imaging based on clinical probability score and D-dimer assay? ................................................ 70

    6.3 Ventilation perfusion scans ................................................................................................. 72

    6.3.1 In people with suspected PE, what is the effectiveness of ventilation perfusion scans in ruling out PE? ......................................................................... 73

    6.4 Computed tomography (CT) scans ....................................................................

Recommended

View more >