Saudi clinical practice guideline for the diagnosis of the first deep venous thrombosis of the lower extremity

The diagnosis of deep venous thrombosis [DVT] may be challenging due to the inaccuracy of clinical assessment and diversity of diagnostic tests. On one hand, missed diagnosis may result in life-threatening conditions. On the other hand, unnecessary treatment may lead to serious complications. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia [KSA], an expert panel led by the Saudi Association for Venous Thrombo-Embolism [SAVTE; a subsidiary of the Saudi Thoracic Society] with the methodological support of the McMaster University Working Group, produced this clinical practice guideline to assist healthcare providers in evidence-based clinical decision-making for the diagnosis of a suspected first DVT of the lower extremity. Twenty-four questions were identified and corresponding recommendations were made following the Grading of Recommendations, Assessment, Development and Evaluation [GRADE] approach. These recommendations included assessing the clinical probability of DVT using Wells criteria before requesting any test and undergoing a sequential diagnostic evaluation, mainly using highly sensitive D-dimer by enzyme-linked immunosorbent assay [ELISA] and compression ultrasound. Although venography is the reference standard test for the diagnosis of DVT, its use was not recommended

Inferior vena caval filters: 5 years of experience in a tertiary care center

Interruption of the Inferior Vena Cava [IVC] is recommended in certain cases to prevent Pulmonary Embolism [PE]. Reported data on the efficacy and rate of complications vary considerably. We conducted a retrospective analysis of patients who had a temporary or permanent IVC filter inserted at our institution during the past 5 years. Seventy-seven of 225 patients [34%] with Venous Thrombosis [VT] had an IVC filter inserted. Deep vein thrombosis and PE were the most common causes for anticoagulation. Bleeding was the reason for IVC filter insertion in 48 [62%]. The only complication found was the breaking of a temporary filter during removal related to the procedure. However, 3 patients [out of 10] had a recurrence of VT after prolonged discontinuation of anticoagulation. Our criteria for indication of IVC filter insertion are in line with current standard of care. The immediate and delayed complications caused by IVC filter insertion was low. Active bleeding was the most common indication for filter insertion, whereas inherited thrombophilia was relatively common