LEAWOOD, Kan. – The American Academy of Family Physicians (AAFP) and American College of Physicians (ACP) today released new clinical practice guidelines for the diagnosis and management of venous thromboembolism (VTE).
Key elements of the diagnosis guideline include the use of clinical prediction rules to establish pretest probability of deep vein thrombosis or pulmonary embolism in a patient before further testing and the utility of various diagnostic tools such as D-dimer and ultrasonography. The management guideline supports the use of low-molecular weight heparin for patients with deep vein thrombosis in the outpatient setting when appropriate support services are in place. Each guideline contains several recommendations to aid in the diagnosis and treatment of lower extremity deep venous thrombosis and pulmonary embolism.
A thromboembolism occurs when a blood clot, formed at one point in the circulatory system, detaches and obstructs circulation at another point. A pulmonary embolism occurs when such a clot, usually originating in the veins of the leg, obstructs the pulmonary artery or one of its branches. A large embolus may result in acute heart failure or sudden death. More than 200,000 deaths each year are associated with VTE in the United States.
The Annals of Family Medicine and Annals of Internal Medicine have joined in publishing the new guidelines. Both guidelines and an evidence review for the diagnosis guideline are published in this issue of Annals of Family Medicine. The management guideline is being published at www.annals.org on Monday, Jan. 29, at 6 p.m. EST. The management guideline and companion evidence review will be published in the Feb. 6, 2007, issue of Annals of Internal Medicine.
The new diagnosis guideline targets primary care physicians who are most likely to have frontline contact with patients who have not yet been diagnosed. The guideline aims to present evidence-based recommendations for diagnosis of lower extremity DVT and pulmonary embolism.
"These new guidelines represent a collaborative effort between family medicine and internal medicine," said Rick Kellerman, M.D., AAFP president. "We are pleased to collaborate with the American College of Physicians on this endeavor to provide physicians with the tools they need to prevent mortality and morbidity associated with venous thromboembolism."
Incidence rates for VTE are higher in men, African-Americans, and increase substantially with age. Treating VTE at an early stage can avoid complications such as pulmonary embolism or recurrent DVT.
"ACP has been producing evidence-based clinical practice guidelines since 1981 to help physicians provide the best health care possible, based on the best available current evidence," said Amir Qaseem, MD, PhD, MHA, senior medical associate in the Clinical Programs and Quality of Care department of the Medical Education and Publishing Division at the American College of Physicians. "These guidelines provide information on the utility of various diagnostic tools and compare the efficacy and safety of various pharmacologic agents used for treatment of VTE."
AMERICAN ACADEMY OF FAMILY PHYSICIANS
Founded in 1947, the AAFP represents nearly 94,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.
Nearly one in four of all office visits are made to family physicians. That is 207 million office visits each year – nearly 62 million more than to the next medical specialty. Today, family physicians provide the majority of care for America's underserved and rural populations.
In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, family physicians are dedicated to treating the whole person across the full spectrum of ages. Family medicine's cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.
To learn more about the American Academy of Family Physicians and about the specialty of family medicine, please visit www.aafp.org.
AMERICAN COLLEGE OF PHYSICIANS
The American College of Physicians (www.acponline.org) is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 120,000 internal medicine physicians (internists), related subspecialists, medical students, residents and fellows.
Internists specialize in the prevention, detection, and treatment of illness in adults, reflected in the organization's trademarked phrase "Doctors of Internal Medicine. Doctors for Adults.®"
ACP provides information and advocacy for its members as they practice general internal medicine and related subspecialties. ACP members are also involved in medical education, research, and administration.
The American College of Physicians was founded in 1915 to promote the science and practice of medicine. In 1998 it merged with the American Society of Internal Medicine, which was established in 1956 to study economic aspects of medicine. ACP works to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.
Journal
The Annals of Family Medicine