Re: Antenatal venous thromboembolism

Abstract

Please note that letters and emails to the editor should be no more than 500 words with a maximum of five references.Re: Antenatal venous thromboembolism Dear Editor, I was very interested in the article on antenatal venous thromboembolism 1 published in The Obstetrician & Gynaecologist (TOG) in Volume 23 Issue 3 and would like to complement the authors on the well-written article.While reading the same, I stumbled upon a discrepancy between the article and the Green-top Guideline No. 37b on Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management, 2 regarding the management of suspected deep vein thrombosis (DVT) in pregnant patients. This aforementioned TOG article, on page 207, under the paragraph with the sub-heading 'Deep vein thrombosis' in the sixth sentence (eighth line) mentions, "However, if there is a persistent clinical suspicion, RCOG guidance recommends that treatment should be continued and ultrasound repeated 3 and 7 days later." Upon reviewing the Green-top Guideline, the recommendation on page 2 of 32 under the question, "What investigations are needed for the diagnosis of an acute DVT?" states in the second paragraph under the above question "If ultrasound is negative and there is a low level of clinical suspicion, anticoagulant treatment can be discontinued." It continues to recommend further action on an ultrasound that is negative as follows: "If ultrasound is negative and a high level of clinical suspicion exists, anticoagulant treatment should be discontinued but the ultrasound should be repeated on days 3 and 7. [New 2015]".I would like to draw the attention of the authors to this discrepancy and would appreciate clarification on this, enabling the readers to take home a clear message. Along the journey of continued learning and reflecting, I would also like to learn if I have possibly made an error in reading or understanding the intended guidance or the article. Though I agree with the authors that if there exists a strong clinical suspicion, continuing the anticoagulant treatment makes a lot more sense; but I then question what the repeat tests on day 3 and 7 may show, as they may cause possible resolution of any thrombosis that may have been there.