{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:30:42Z","timestamp":1787873442007,"version":"build-2784847793"},"reference-count":118,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,2]],"date-time":"2020-06-02T00:00:00Z","timestamp":1591056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V\/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.<\/jats:p>","DOI":"10.3390\/diagnostics10060365","type":"journal-article","created":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T04:12:09Z","timestamp":1591157529000},"page":"365","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Advances in the Diagnosis of Venous Thromboembolism: A Literature Review"],"prefix":"10.3390","volume":"10","author":[{"given":"Harish","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haozhe","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali N.","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trupti","family":"Vakde","sequence":"additional","affiliation":[{"name":"Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA"},{"name":"Division of the Pulmonary and Critical Care, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY 10457, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1001\/archinte.1991.00400050081016","article-title":"A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study","volume":"151","author":"Anderson","year":"1991","journal-title":"Arch. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1001\/archinte.158.6.585","article-title":"Trends in the incidence of deep vein thrombosis and pulmonary embolism: A 25-year population-based study","volume":"158","author":"Silverstein","year":"1998","journal-title":"Arch. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2007.02450.x","article-title":"Incidence and mortality of venous thrombosis: A population-based study","volume":"5","author":"Naess","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S495","DOI":"10.1016\/j.amepre.2009.12.017","article-title":"Venous Thromboembolism","volume":"38","author":"Beckman","year":"2010","journal-title":"Am. J. Prev. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1038\/nrcardio.2015.83","article-title":"Epidemiology of venous thromboembolism","volume":"12","author":"Heit","year":"2015","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.amjmed.2014.03.041","article-title":"Secular trends in occurrence of acute venous thromboembolism: The Worcester VTE study (1985\u20132009)","volume":"127","author":"Huang","year":"2014","journal-title":"Am. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.chest.2016.02.638","article-title":"Analysis of National Trends in Admissions for Pulmonary Embolism","volume":"150","author":"Smith","year":"2016","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.thromres.2012.07.011","article-title":"Trends in case fatality rate in pulmonary embolism according to stability and treatment","volume":"130","author":"Stein","year":"2012","journal-title":"Thromb. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1001\/archsurg.1976.01360190036005","article-title":"The diagnosis of deep venous thrombosis. Fallibility of clinical symptoms and signs","volume":"111","author":"Cranley","year":"1976","journal-title":"Arch. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1111\/jth.13805","article-title":"Disease prevalence dependent failure rate in diagnostic management studies on suspected deep vein thrombosis: Communication from the SSC of the ISTH","volume":"15","author":"Dronkers","year":"2017","journal-title":"J. Thromb. Haemost."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"g1340","DOI":"10.1136\/bmj.g1340","article-title":"Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: Individual patient data meta-analysis","volume":"348","author":"Geersing","year":"2014","journal-title":"Br. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.7326\/M16-0031","article-title":"Wells Rule and D-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data Meta-analysis","volume":"165","author":"Douma","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"516420","DOI":"10.1155\/2013\/516420","article-title":"The role of thrombophilia in pregnancy","volume":"2013","author":"Battinelli","year":"2013","journal-title":"Thrombosis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"697","DOI":"10.7326\/0003-4819-143-10-200511150-00006","article-title":"Trends in the incidence of venous thromboembolism during pregnancy or postpartum: A 30-year population-based study","volume":"143","author":"Heit","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1001\/archinte.162.11.1245","article-title":"Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: A population-based study","volume":"162","author":"Heit","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.thromres.2005.10.015","article-title":"Chemotherapy-induced thrombosis","volume":"118","author":"Haddad","year":"2006","journal-title":"Thromb. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1182\/hematology.2019000024","article-title":"Update from the clinic: What\u2019s new in the diagnosis of cancer-associated thrombosis?","volume":"2019","author":"Peterson","year":"2019","journal-title":"Hematology Am. Soc. Hematol. Educ. Program"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1161\/CIRCRESAHA.115.306841","article-title":"Global Burden of Thrombosis: Epidemiologic Aspects","volume":"118","author":"Wendelboe","year":"2016","journal-title":"Circ. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1160\/TH07-03-0212","article-title":"Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality","volume":"98","author":"Cohen","year":"2007","journal-title":"Thromb. Haemost."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1111\/jth.13694","article-title":"Diagnosis of acute pulmonary embolism","volume":"15","author":"Righini","year":"2017","journal-title":"J. Thromb. Haemost."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"I4","DOI":"10.1161\/01.CIR.0000078468.11849.66","article-title":"The epidemiology of venous thromboembolism","volume":"107","author":"White","year":"2003","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1164\/ajrccm.159.3.9806130","article-title":"Accuracy of clinical assessment in the diagnosis of pulmonary embolism","volume":"159","author":"Miniati","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4186","DOI":"10.1093\/eurheartj\/ehy631","article-title":"Differential impact of syncope on the prognosis of patients with acute pulmonary embolism: A systematic review and meta-analysis","volume":"39","author":"Barco","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/j.1538-7836.2004.00790.x","article-title":"Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism","volume":"2","author":"Kline","year":"2004","journal-title":"J. Thromb. Haemost."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e615","DOI":"10.1016\/S2352-3026(17)30210-7","article-title":"Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): A multicentre, prospective, observational study","volume":"4","author":"Penaloza","year":"2017","journal-title":"Lancet Haematol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1001\/jama.2017.21904","article-title":"Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial","volume":"319","author":"Freund","year":"2018","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Sanders, S., Doust, J., and Glasziou, P. (2015). A systematic review of studies comparing diagnostic clinical prediction rules with clinical judgment. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0128233"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"253","DOI":"10.7326\/M16-0031","article-title":"Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data Meta-analysis","volume":"165","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1538-7836.2007.02820.x","article-title":"Comparison of the revised Geneva score with the Wells rule for assessing clinical probability of pulmonary embolism","volume":"6","author":"Klok","year":"2008","journal-title":"J. Thromb. Haemost."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1111\/jgs.13459","article-title":"Comparison of Wells and Revised Geneva Rule to Assess Pretest Probability of Pulmonary Embolism in High-Risk Hospitalized Elderly Adults","volume":"63","author":"Cilia","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1001\/archinte.168.19.2131","article-title":"Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism","volume":"168","author":"Klok","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/j.1538-7836.2010.03801.x","article-title":"Clinical prediction rules for pulmonary embolism: A systematic review and meta-analysis","volume":"8","author":"Ceriani","year":"2010","journal-title":"J. Thromb. Haemost."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"491","DOI":"10.4103\/1947-2714.143278","article-title":"Effectiveness of D-dimer as a screening test for venous thromboembolism: An update","volume":"6","author":"Pulivarthi","year":"2014","journal-title":"N. Am. J. Med. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1001\/jama.2014.2135","article-title":"Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: The ADJUST-PE study","volume":"311","author":"Righini","year":"2014","journal-title":"JAMA"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S0140-6736(17)30885-1","article-title":"Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): A prospective, multicentre, cohort study","volume":"390","author":"Cheung","year":"2017","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1055\/s-0029-1214148","article-title":"The role of D-dimer testing in patients with suspected venous thromboembolism","volume":"35","author":"Prisco","year":"2009","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e005611","DOI":"10.1136\/bmjopen-2014-005611","article-title":"Current and future use of point-of-care tests in primary care: An international survey in Australia, Belgium, The Netherlands, the UK and the USA","volume":"4","author":"Howick","year":"2014","journal-title":"BMJ Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"b2990","DOI":"10.1136\/bmj.b2990","article-title":"Excluding venous thromboembolism using point of care D-dimer tests in outpatients: A diagnostic meta-analysis","volume":"339","author":"Geersing","year":"2009","journal-title":"BMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1177\/1358863X10378788","article-title":"Diagnosis of venous thromboembolism: An update","volume":"15","author":"Bounameaux","year":"2010","journal-title":"Vasc. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.thromres.2013.08.014","article-title":"The role of soluble P selectin in the diagnosis of venous thromboembolism","volume":"133","author":"Antonopoulos","year":"2014","journal-title":"Thromb. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"13835","DOI":"10.1073\/pnas.250475997","article-title":"Pro-coagulant state resulting from high levels of soluble P-selectin in blood","volume":"97","author":"Andre","year":"2000","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1084\/jem.175.4.1147","article-title":"Characterization of GMP-140 (P-selectin) as a circulating plasma protein","volume":"175","author":"Dunlop","year":"1992","journal-title":"J. Exp. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1160\/TH05-06-0426","article-title":"D-dimer, P-selectin, and microparticles: Novel markers to predict deep venous thrombosis. A pilot study","volume":"94","author":"Rectenwald","year":"2005","journal-title":"Thromb. Haemost."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2703","DOI":"10.1182\/blood-2008-02-142422","article-title":"High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: Results from the Vienna Cancer and Thrombosis Study (CATS)","volume":"112","author":"Ay","year":"2008","journal-title":"Blood"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1161\/ATVBAHA.109.190827","article-title":"High factor VIII levels independently predict venous thromboembolism in cancer patients: The cancer and thrombosis study","volume":"29","author":"Vormittag","year":"2009","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"17261","DOI":"10.1016\/S0021-9258(19)47368-7","article-title":"Platelet-derived microparticles express high affinity receptors for factor VIII","volume":"266","author":"Gilbert","year":"1991","journal-title":"J. Biol. Chem."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4382","DOI":"10.4049\/jimmunol.161.8.4382","article-title":"Endothelial cell activation by leukocyte microparticles","volume":"161","author":"Mesri","year":"1998","journal-title":"J. Immunol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1006\/jsre.2002.6552","article-title":"Selectins influence thrombosis in a mouse model of experimental deep venous thrombosis","volume":"108","author":"Myers","year":"2002","journal-title":"J. Surg. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00277-010-1111-1","article-title":"Circulating procoagulant microparticles in cancer patients","volume":"90","author":"Thaler","year":"2011","journal-title":"Ann. Hematol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"6830","DOI":"10.1158\/1078-0432.CCR-09-0371","article-title":"Tumor-Derived Tissue Factor\u2013Bearing Microparticles Are Associated With Venous Thromboembolic Events in Malignancy","volume":"15","author":"Zwicker","year":"2009","journal-title":"Clin. Cancer Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7326\/0003-4819-125-1-199607010-00001","article-title":"The long-term clinical course of acute deep venous thrombosis","volume":"125","author":"Prandoni","year":"1996","journal-title":"Ann. Intern. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1086\/316903","article-title":"Genetic susceptibility to thrombosis and its relationship to physiological risk factors: The GAIT study. Genetic Analysis of Idiopathic Thrombophilia","volume":"67","author":"Souto","year":"2000","journal-title":"Am. J. Hum. Genet."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s11239-018-1762-7","article-title":"Risk prediction of recurrent venous thromboembolism: A multiple genetic risk model","volume":"47","author":"Ahmad","year":"2019","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1001\/jama.295.2.172","article-title":"Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography","volume":"295","author":"Buller","year":"2006","journal-title":"JAMA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.1001\/jama.1990.03440200057023","article-title":"Value of the ventilation\/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED)","volume":"263","author":"Michael","year":"1990","journal-title":"JAMA"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1148\/radiology.217.2.r00nv01447","article-title":"Pulmonary embolism detection: Prospective evaluation of dual-section helical CT versus selective pulmonary arteriography in 157 patients","volume":"217","author":"Qanadli","year":"2000","journal-title":"Radiology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1164\/rccm.201108-1575ST","article-title":"An official American Thoracic Society\/Society of Thoracic Radiology clinical practice guideline: Evaluation of suspected pulmonary embolism in pregnancy","volume":"184","author":"Leung","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1111\/j.1538-7836.2010.03938.x","article-title":"Subsegmental pulmonary embolism diagnosed by computed tomography: Incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies","volume":"8","author":"Carrier","year":"2010","journal-title":"J. Thromb. Haemost."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1056\/NEJMoa052367","article-title":"Multidetector computed tomography for acute pulmonary embolism","volume":"354","author":"Stein","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_60","first-page":"1119","article-title":"Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations","volume":"34","author":"Gottschalk","year":"1993","journal-title":"J. Nucl. Med."},{"key":"ref_61","first-page":"13n","article-title":"Appropriate Use Criteria for Ventilation-Perfusion Imaging in Pulmonary Embolism: Summary and Excerpts","volume":"58","author":"Waxman","year":"2017","journal-title":"J. Nucl. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1148\/radiol.2463070270","article-title":"Acute pulmonary embolism: Sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study","volume":"246","author":"Sostman","year":"2008","journal-title":"Radiology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ejhf.478","article-title":"Contemporary management of acute right ventricular failure: A statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology","volume":"18","author":"Harjola","year":"2016","journal-title":"Eur. J. Heart Fail."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/j.echo.2016.05.016","article-title":"Echocardiographic Pattern of Acute Pulmonary Embolism: Analysis of 511 Consecutive Patients","volume":"29","author":"Kurnicka","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0002-9149(02)02523-7","article-title":"Disturbed right ventricular ejection pattern as a new Doppler echocardiographic sign of acute pulmonary embolism","volume":"90","author":"Kurzyna","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.jcmg.2013.11.004","article-title":"Prognostic value of echocardiography in normotensive patients with acute pulmonary embolism","volume":"7","author":"Pruszczyk","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1093\/eurheartj\/ehr108","article-title":"Multidetector computed tomography for acute pulmonary embolism: Diagnosis and risk stratification in a single test","volume":"32","author":"Becattini","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1161\/CIRCULATIONAHA.106.680421","article-title":"Prognostic value of troponins in acute pulmonary embolism: A meta-analysis","volume":"116","author":"Becattini","year":"2007","journal-title":"Circulation"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.revmed.2012.05.012","article-title":"Epidemiology and management of isolated distal deep venous thrombosis","volume":"33","author":"Galanaud","year":"2012","journal-title":"Rev. Med. Interne."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1111\/j.1538-7836.2008.02981.x","article-title":"D-Dimer for venous thromboembolism diagnosis: 20 years later","volume":"6","author":"Righini","year":"2008","journal-title":"J. Thromb. Haemost."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/S0140-6736(98)05248-9","article-title":"Non-invasive diagnosis of venous thromboembolism in outpatients","volume":"353","author":"Perrier","year":"1999","journal-title":"Lancet"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1080\/00365513.2017.1390783","article-title":"Age-adjusted D-dimer cut-off in the diagnostic strategy for deep vein thrombosis: A systematic review","volume":"77","author":"Nybo","year":"2017","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1161\/01.CIR.64.3.622","article-title":"Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis","volume":"64","author":"Hull","year":"1981","journal-title":"Circulation"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"21","DOI":"10.7326\/0003-4819-102-1-21","article-title":"Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial","volume":"102","author":"Hull","year":"1985","journal-title":"Ann. Intern. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1055\/s-0038-1648130","article-title":"Contrast venography, the gold standard for the diagnosis of deep-vein thrombosis: Improvement in observer agreement","volume":"67","author":"Lensing","year":"1992","journal-title":"Thromb. Haemost."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/S0009-9260(81)80197-3","article-title":"Complications of phlebography: A randomised comparison between an ionic and a non-ionic contrast medium","volume":"32","author":"Berge","year":"1981","journal-title":"Clin. Radiol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"663","DOI":"10.7326\/0003-4819-128-8-199804150-00011","article-title":"Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative","volume":"128","author":"Kearon","year":"1998","journal-title":"Ann. Intern. Med."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Goodacre, S., Sampson, F., Thomas, S., van Beek, E., and Sutton, A. (2005). Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med. Imaging, 5.","DOI":"10.1186\/1471-2342-5-6"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1160\/TH12-07-0473","article-title":"Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: A systematic review and meta-analysis","volume":"109","author":"Pomero","year":"2013","journal-title":"Thromb. Haemost."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1538-7836.2008.02921.x","article-title":"Pregnancy, the postpartum period and prothrombotic defects: Risk of venous thrombosis in the MEGA study","volume":"6","author":"Pomp","year":"2008","journal-title":"J. Thromb. Haemost."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/AOG.0000000000002114","article-title":"Pregnancy-Related Mortality in the United States, 2011-2013","volume":"130","author":"Creanga","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"i6253","DOI":"10.1136\/bmj.i6253","article-title":"Development and validation of risk prediction model for venous thromboembolism in postpartum women: Multinational cohort study","volume":"355","author":"Sultan","year":"2016","journal-title":"BMJ"},{"key":"ref_83","first-page":"56","article-title":"Venous thromboembolism in pregnancy and the puerperium: Incidence and additional risk factors from a London perinatal database","volume":"108","author":"Simpson","year":"2001","journal-title":"BJOG"},{"key":"ref_84","first-page":"730","article-title":"Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy","volume":"94","author":"Gherman","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1056\/NEJMra0707993","article-title":"Venous Thromboembolic Disease and Pregnancy","volume":"359","author":"Marik","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Van Mens, T.E., Scheres, L.J.J., de Jong, P.G., Leeflang, M.M.G., Nijkeuter, M., and Middeldorp, S. (2017). Imaging for the exclusion of pulmonary embolism in pregnancy. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD011053.pub2"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/1471-0528.12855","article-title":"Gestation-specific D-dimer reference ranges: A cross-sectional study","volume":"122","author":"Murphy","year":"2015","journal-title":"BJOG"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"766","DOI":"10.7326\/M18-1670","article-title":"Diagnosis of Pulmonary Embolism During Pregnancy: A Multicenter Prospective Management Outcome Study","volume":"169","author":"Righini","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1053\/j.semnuclmed.2010.07.007","article-title":"Radiation dosimetry and safety issues in the investigation of pulmonary embolism","volume":"40","author":"Schembri","year":"2010","journal-title":"Semin. Nucl. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ejrad.2016.11.011","article-title":"Contrast monitoring techniques in CT pulmonary angiography: An important and underappreciated contributor to breast dose","volume":"86","author":"Mitchell","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1148\/radiol.11114045","article-title":"American Thoracic Society documents: An official American Thoracic Society\/Society of Thoracic Radiology Clinical Practice Guideline\u2014Evaluation of Suspected Pulmonary Embolism in Pregnancy","volume":"262","author":"Leung","year":"2012","journal-title":"Radiology"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"434","DOI":"10.7326\/0003-4819-152-7-201004060-00008","article-title":"Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: A multicenter prospective study (PIOPED III)","volume":"152","author":"Stein","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/00006254-199507000-00020","article-title":"Use of thrombolytics for the treatment of thromboembolic disease during pregnancy","volume":"50","author":"Turrentine","year":"1995","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1001\/archinte.162.11.1221","article-title":"Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator: A case report and review of treatment options","volume":"162","author":"Ahearn","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1177\/1753495X13488771","article-title":"The use of thrombolytic therapy in pregnancy","volume":"6","author":"Gartman","year":"2013","journal-title":"Obstet Med"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"330A","DOI":"10.1016\/j.chest.2018.08.303","article-title":"Catheter Directed Thrombolysis for Massive Pulmonary Embolism in a Pregnant Patient","volume":"154","author":"Goldbach","year":"2018","journal-title":"Chest"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/00006254-199904000-00023","article-title":"Deep vein thrombosis during pregnancy and the puerperium: A meta-analysis of the period of risk and the leg of presentation","volume":"54","author":"Ray","year":"1999","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"569","DOI":"10.23736\/S0392-9590.17.03865-2","article-title":"Gestational lower limb edema and venous reflux in healthy primigravidae","volume":"36","author":"Gardenghi","year":"2017","journal-title":"Int. Angiol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1503\/cmaj.091692","article-title":"Anatomic distribution of deep vein thrombosis in pregnancy","volume":"182","author":"Chan","year":"2010","journal-title":"CMAJ"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7326\/0003-4819-151-2-200907210-00004","article-title":"Predicting deep venous thrombosis in pregnancy: Out in \u201cLEFt\u201d field?","volume":"151","author":"Chan","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1586\/erc.09.136","article-title":"Diagnosis of venous thromboembolism in pregnancy: A study in extrapolation or a science in evolution?","volume":"7","author":"Chan","year":"2009","journal-title":"Expert. Rev. Cardiovasc. Ther."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1080\/01443610801915975","article-title":"A negative D-dimer does not exclude venous thromboembolism (VTE) in pregnancy","volume":"28","author":"To","year":"2008","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"165","DOI":"10.7326\/0003-4819-147-3-200708070-00005","article-title":"A red blood cell agglutination D-dimer test to exclude deep venous thrombosis in pregnancy","volume":"147","author":"Chan","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.crad.2005.08.015","article-title":"Diagnosis of suspected venous thromboembolic disease in pregnancy","volume":"61","author":"Scarsbrook","year":"2006","journal-title":"Clin. Radiol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1046\/j.1469-0705.1996.08020093.x","article-title":"Venous circulation in the maternal lower limb: A Doppler study with the Valsalva maneuver","volume":"8","author":"Palmgren","year":"1996","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/00005382-200110000-00011","article-title":"Combined CT pulmonary angiography and venography for diagnosis of pulmonary embolism and deep vein thrombosis: Radiation dose","volume":"16","author":"Rademaker","year":"2001","journal-title":"J. Thorac. Imaging"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.thromres.2010.05.011","article-title":"Magnetic resonance imaging and ultrasonography in diagnosis of pelvic vein thrombosis during pregnancy","volume":"126","author":"Torkzad","year":"2010","journal-title":"Thromb. Res."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1136\/bmj.332.7535.215","article-title":"Venous thromboembolism","volume":"332","author":"Blann","year":"2006","journal-title":"BMJ"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"394740","DOI":"10.4061\/2011\/394740","article-title":"Arterial and venous thrombosis in cancer patients","volume":"2011","author":"Blann","year":"2011","journal-title":"Cardiol. Res. Pract."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/j.1538-7836.2007.02374.x","article-title":"Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy","volume":"5","author":"Khorana","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"448","DOI":"10.7326\/0003-4819-155-7-201110040-00007","article-title":"Clinical decision rules for excluding pulmonary embolism: A meta-analysis","volume":"155","author":"Lucassen","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1160\/TH10-02-0093","article-title":"Clinical decision rule and D-dimer have lower clinical utility to exclude pulmonary embolism in cancer patients. Explanations and potential ameliorations","volume":"104","author":"Douma","year":"2010","journal-title":"Thromb. Haemost."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.6004\/jnccn.2018.0084","article-title":"NCCN Guidelines Insights: Cancer-Associated Venous Thromboembolic Disease, Version 2.2018","volume":"16","author":"Streiff","year":"2018","journal-title":"J. Natl. Compr. Canc. Netw."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1200\/JOP.19.00368","article-title":"Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update Summary","volume":"15","author":"Key","year":"2019","journal-title":"J. Oncol. Pract."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"4902","DOI":"10.1182\/blood-2007-10-116327","article-title":"Development and validation of a predictive model for chemotherapy-associated thrombosis","volume":"111","author":"Khorana","year":"2008","journal-title":"Blood"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.3324\/haematol.2018.209114","article-title":"The Khorana score for prediction of venous thromboembolism in cancer patients: A systematic review and meta-analysis","volume":"104","author":"Mulder","year":"2019","journal-title":"Haematologica"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.3324\/haematol.2017.169060","article-title":"Comparison of risk prediction scores for venous thromboembolism in cancer patients: A prospective cohort study","volume":"102","author":"Cesarman","year":"2017","journal-title":"Haematologica"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1634\/theoncologist.2016-0414","article-title":"A Predictive Score for Thrombosis Associated with Breast, Colorectal, Lung, or Ovarian Cancer: The Prospective COMPASS-Cancer-Associated Thrombosis Study","volume":"22","author":"Gerotziafas","year":"2017","journal-title":"Oncologist"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/6\/365\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:35:00Z","timestamp":1760175300000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/10\/6\/365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,2]]},"references-count":118,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["diagnostics10060365"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics10060365","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,2]]}}}