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Author Response
Submit responseOur recommendations are based on only evidence from randomized controlled trials. That is why the studies that were mentioned in the letters comparing the efficacy of LMWH vs. UFH as well as for safety of heparin and warfarin during pregnancy were not mentioned in the guideline. However, LMWH is more cost-effective compared to UFH. Although there are many studies evaluating prophylactic use of LMWH in pregnant women, the evidence is scarce for treating DVT or PE in pregnant women.
Conflict of Interest:
None declared
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Applying your guidelines for Upper Limb Deep Vein Thrombosis?
Submit responseThis article highlights the important aspects of diagnosing venous thromboembolism. The article however does not clarify if these guidelines are applicable for suspected Upper limb deep vein thrombosis. I am aware that there has been no trial evidence testing the Well's score for suspected upper limb deep vein thrombosis but from a pragmatic sense, upper limb deep veins are not much different to lower limb deep veins.
Conflict of Interest:
General Medicine
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Delay in Thromboembolism Evaluation
Submit responseThe article by Quseem and colleagues provides a clinical practice guideline regarding the diagnosis of lower extremity deep vein thrombosis and pulmonary embolism specifically addressed to primary care physicians. High-sensitive D-dimer assay is recommended in appropriately selected patients with low pretest probability by the Wells predition rules.
Rapid institution of therapy has always been a priority in thromboembolism. Few primary care physicians have access to same day test results. The issue of time was not discussed in the guidelines but should be a factor in the decision making.
Conflict of Interest:
None declared