BC Guidelines are clinical practice guidelines and protocols that provide recommendations to B.C. practitioners on delivering high quality, appropriate care to patients with specific clinical conditions or diseases. These “Made in BC” clinical practice guidelines are developed by the Guidelines and Protocol Advisory Committee (GPAC), an advisory committee to the Medical Services Commission. The primary audience for BC Guidelines is BC physicians, nurse practitioners, and medical students. However, other audiences such as health educators, health authorities, allied health organizations, pharmacists, and nurses may also find them to be a useful resource.
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NEW: Venous Thromboembolism - Diagnosis and Management
Venous Thromboembolism – Diagnosis and Management (2024) provides recommendations for the diagnosis and management of venous thromboembolism (VTE) in adults aged ≥ 19 years with hemodynamic stability. It includes lower limb deep vein thrombosis (DVT) and pulmonary embolism (PE) diagnosis in the outpatient setting and management of acute VTE.
Superficial thrombophlebitis and thrombosis in unusual sites (e.g., cerebral venous thrombosis, splanchnic vein thrombosis, upper extremity thrombosis) are outside the scope of this guideline. For information refer to the Thrombosis Canada Guidelines.
Key Recommendations include:
When DVT/PE is suspected, first calculate the Wells Score to determine the likelihood of DVT/PE as “likely” or “unlikely” before ordering any testing.
For outpatients with suspected DVT/PE:
Do not order D-dimer if DVT/PE is deemed “likely” per Wells Score. Proceed directly to imaging.
Order D-dimer when deemed ‘unlikely’ per Wells Score because a negative test indicates imaging is not necessary and DVT/PE is excluded.
For inpatients, proceed directly to imaging because risk stratification using D-dimer has not been validated.
While awaiting objective imaging to diagnose VTE, start empiric anticoagulant therapy in Patients with higher likelihood (“likely”) of DVT/PE.
Most patients with hemodynamically stable VTE can be treated on an outpatient basis.
Direct Oral Anticoagulants (DOACs) are considered as first line therapies for most outpatients. They are contraindicated in pregnancy, breastfeeding, liver failure (Child-Pugh class C), dialysis, or triple-positive antiphospholipid syndrome (i.e., has lupus anticoagulant, anticardiolipin and antibeta-2-glycoprotein-1 antibodies).
Ensure appropriate anticoagulant dosage is used for the specific treatment phase (initial therapy, primary treatment, secondary prevention).
Minimum duration of anticoagulation is 3-6 months for all patients with an acute DVT/PE.
Referral to a thrombosis specialist is recommended to help determine optimal duration of anticoagulation. Continue anticoagulation therapy while awaiting referral.
Avoid elective surgeries during the first 3-6 months of treatment.
Hereditary thrombophilia testing and occult cancer screening are not indicated in most patients with thrombosis because results rarely influence management.
Revised: Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management in Primary Care
Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management in Primary Care (2024) provides recommendations for adults with chronic obstructive pulmonary disease (COPD) in primary care.
Key Recommendations include:
Diagnosis
Management
Environmental Impact and Climate Change
Education