[NHG guideline 'Deep-vein thrombosis and pulmonary embolus']

Area of Science:

• Medical Guidelines
• Cardiovascular Medicine
• General Practice

Background:

• The Nederlands Huisartsen Genootschap (NHG) has updated its guideline on deep-vein thrombosis (DVT) and pulmonary embolism (PE).
• General practitioners (GPs) require clear protocols for diagnosing and managing these conditions.

Purpose of the Study:

• To provide updated recommendations for GPs on the management of DVT, thrombophlebitis, and the exclusion of PE.
• To outline diagnostic strategies, including decision rules and D-dimer testing, for primary care settings.

Main Methods:

• The guideline incorporates clinical decision rules and the use of D-dimer testing for excluding DVT and PE.
• It details treatment approaches for DVT, including anticoagulant therapy and ultrasound follow-up.
• Recommendations for managing superficial thrombophlebitis are also included.

Main Results:

• GPs can exclude DVT or PE in select patients using a combination of a decision rule and a D-dimer test.
• The guideline advises against direct oral anticoagulants for DVT treatment within primary care.
• For isolated calf DVT, treatment options include anticoagulants or ultrasound follow-up, decided in consultation with the patient.
• Superficial thrombophlebitis management typically involves a conservative, wait-and-see approach.

Conclusions:

• The revised NHG guideline provides GPs with practical tools for the diagnosis and management of DVT and PE.
• Emphasis is placed on appropriate use of diagnostic tests and conservative management strategies where applicable.
• The guideline supports patient-centered care through shared decision-making for DVT treatment options.