Table 1.

Consensus Statements on DVT.

DVT—From clinical suspicion to diagnosis
1	It is desirable that the diagnostic work-up of the DVT should be completed in the Emergency Department (ED) with a multidisciplinary approach that can be variable depending on levels of care of the ED.
2	The clinical manifestations of DVT are not specific: the diagnostic process must be guided by the pre-test clinical probability.
3	The dichotomized Wells score proved to be accurate in stratifying the pre-test probability of DVT in ED, therefore it is necessary to acquire the information to calculate it before any further investigation.
4	The determination of D-dimer and the use of non-invasive study of the veins of the lower limbs such as CUS (compressive ultrasonography) is recommended in the DVT diagnostic work-up.
5	It is recommended that each laboratory has a specific reference cut-off for d-dimer test and it is necessary an age-correction during the interpretation of this value.
6	In a patient with Wells pre-test score “unlikely” and negative D-Dimer, the diagnosis of DVT can be reasonably excluded.
7	If Wells score is “unlikely” for DVT and D-Dimer test is positive it is recommended to perform CUS; if CUS is negative it is indicated to perform complete venous ultrasound (US) evaluation (preferably in 48-72 hours); if venous US is negative, the diagnosis is reasonably excluded. If US is not available, it is indicated to perform a second CUS at 5-7 days.
8	If Wells score is “likely” for DVT it is recommended to perform CUS; if CUS is negative, it is indicated to perform a complete venous US evaluation (preferably in 48-72 hours) to rule out isolated distal DVT, if available, or, if not, repeat CUS at 5-7 days.
9	If Wells score is “likely” for DVT with a positive CUS evaluation, it is recommended to start anticoagulant therapy.
10	If the patient has a positive CUS and a positive D-Dimer test the diagnosis of DVT is confirmed regardless of Wells pre-test probability.
11	In pregnant women with significant edema in one or both the lower limbs or with clinical suspected deep venous thrombosis of other vascular districts, evaluation performing venous Ultrasound (US) is mandatory.
12	It is not recommended the use of invasive or expensive tests such as phlebography, CT or MRI for the diagnosis of DVT.
13	In patients with DVT, further investigations are not necessary to exclude Pulmonary Embolism (PE) in absence of specific symptoms.
Patient management with DVT
14	▪ The management of DVT should be as outpatients except in presence of one of them: ▪ ongoing bleeding or high bleeding risk (VTE BLEED risk score); ▪ severe renal failure (eVFG <30 ml/min); ▪ metastatic cancer ▪ massive DVT, involving iliac femoral vein, caval vein or severely symptomatic patients (phlegmasia dolens); ▪ inadequate home-care setting.
15	It is recommended that all EDs refer to shared protocols for the out of hospital management and follow-up of patient with an ED diagnosis and initial treatment of DVT.
Treatment of DVT in the acute phase
16	Prompt initiation of anticoagulant therapy after a diagnosis of DVT is mandatory.
17	Anticoagulant therapy should begin in the ED right after the diagnosis of DVT, regardless of the patient’s subsequent destination.
18	While awaiting for the result of diagnostic evaluation of patient with likely DVT (according to the dichotomized Wells score), anticoagulant therapy can also be considered after weighing both thrombotic and hemorrhagic risk.
19	The choice of the anticoagulant drug must take into account not only the common criteria of good clinical practice, but also patient renal and hepatic function, comorbidities, compliance, preferences and opportunity of early discharge.
20	DOACs (Direct Oral AntiCoagulants) represent the better anticoagulant approach especially for patients discharge directly, or after a brief observation, from ED
21	Vena cava filters placement or endovascular procedures are indicated in patients with DVT and contraindications to anticoagulant therapy, depending on hospital skills and availability.