RT Book, Section
A1 Neumann, Ignacio
A1 Akl, Elie A.
A1 Vandvik, Per Olav
A1 Agoritsas, Thomas
A1 Alonso-Coello, Pablo
A1 Rind, David M.
A1 Santesso, Nancy
A1 Alexander, Paul Elias
A1 Mustafa, Reem A.
A1 Prasad, Kameshwar
A1 Bates, Shannon M.
A1 Schunemann, Holger J.
A1 Guyatt, Gordon
A2 Guyatt, Gordon
A2 Rennie, Drummond
A2 Meade, Maureen O.
A2 Cook, Deborah J.
SR Print(0)
ID 1191942883
T1 How to Use a Patient Management Recommendation: Clinical Practice Guidelines and Decision Analyses
T2 Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179071-0
LK jamaevidence.mhmedical.com/content.aspx?aid=1191942883
RD 2024/10/12
AB CLINICAL  SCENARIOYou  are  an  obstetrician  seeing  a  31-year-old  pregnant  woman  who  had  an  unprovoked  deep  venous  thrombosis  of  the  leg  5  years  ago  that  was  treated  with  warfarin  for  6  months  without  complication.  She  is  no  longer  using  antithrombotic  medication  and  is  otherwise  healthy.  Given  a  possible  increased  risk  of  thrombosis  with  pregnancy,  you  are  considering  discussing  the  possibility  of  low-molecular-weight  heparin  (LMWH)  prophylaxis  for  the  rest  of  the  pregnancy.To  inform  your  discussion,  you  search  first  for  an  evidence-based  recommendation  and  find  the  following  recommendation  from  a  practice  guideline1:  “For  pregnant  women  at  moderate  to  high  risk  of  recurrent  venous  thromboembolism  (VTE)  (single  unprovoked  VTE,  pregnancy-  or  estrogen-related  VTE,  or  multiple  prior  unprovoked  VTE  not  receiving  long-term  anticoagulation),  we  suggest  antepartum  prophylaxis  with  prophylactic-  or  intermediate-dose  LMWH  rather  than  clinical  vigilance  or  routine  care  (weak  recommendation,  based  on  low  confidence  in  effect  estimates).”The  statement  “weak  recommendation,  based  on  low  confidence  in  effect  estimates”  leaves  you  uncomfortable.  You  decide  to  read  further  to  understand  the  recommendation  and  its  rationale.