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

• Main Authors: Fahad Al-Hameed, Hasan M Al-Dorzi, Abdulrahman Shamy, Abdulelah Qadi, Ebtisam Bakhsh, Essam Aboelnazar, Mohamad Abdelaal, Tarig AlKhuwaitir, Mohamed S Al-Moamary, Mohamed S Al-Hajjaj, Jan Brozek, Holger Schunemann, Reem Mustafa, Maicon Falavigna
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Annals of Thoracic Medicine
• Subjects: Clinical practice guideline; deep venous thrombosis; diagnosis; Saudi Arabia; venous thromboembolism
• Online Access: http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2015;volume=10;issue=1;spage=3;epage=15;aulast=Al-Hameed
• ISSN: 1817-1737; 1998-3557

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.