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Based on a systematic review of the literature, the American Academy of Family Physicians and the American College of Physicians have published a clinical practice guideline for the diagnosis of venous thromboembolism (VTE) in primary care. The guideline recommends the following measures:
1. Use validated clinical prediction rules (e.g., Wells rules for deep venous thrombosis [DVT] and pulmonary embolism [PE]) to estimate the pretest probability of VTE and to interpret subsequent tests.
2. High-sensitivity d-dimer testing is a reasonable option in selected patients with a low probability of DVT or PE and in situations in which negative results indicate a low likelihood of VTE.
3. Ultrasound is recommended for patients with an intermediate or h…