Clinical Decision Rules and D-dimer in Venous Thromboembolism: Current controversies and future research priorities

•Clinical Decision Rules (CDRs) and D-Dimer are cornerstones of VTE management•Methodologic standards in CDR development minimizes risk that these tools fail in clinical practice•The current prediction tools used in VTE management have limitations that should be appreciated

Venous thromboembolism (VTE) is a potentially lethal clinical condition that is suspected in patients with common clinical complaints, in many and varied, clinical care settings. Once VTE is diagnosed, optimal therapeutic management (thrombolysis, IVC filters, type and duration of anticoagulants) and ideal therapeutic management settings (outpatient, critical care) are also controversial. Clinical prediction tools, including clinical decision rules and D-Dimer, have been developed, and some validated, to assist clinical decision making along the diagnostic and therapeutic management paths for VTE. Despite these developments, practice variation is high and there remain many controversies in the use of the clinical prediction tools. In this narrative review, we highlight challenges and controversies in VTE diagnostic and therapeutic management with a focus on clinical decision rules and D-Dimer.