We thank Wenderlein for his comments. His explanations are practice-relevant and reasonable. They might be helpful to readers when implementing the guideline in outpatient practice.
Naturally, we were not able to address all specialist aspects in detail in the article (1).Our article incorporated in the general and special sections covering all 27 disciplines addressed by the guideline and is restricted in terms of coverage and word count. Thus, the article’s purpose was to stimulate the use of the long version of the guideline (www.awmf.org/leitlinien/detail/ll/003–001.html). Especially obstetrics and gynecology are extensively dealt with in the guideline. All the arguments raised in the letter to the editor are dealt with extensively in the long version.
The epidemiological review by Heit et al. (2) and a review by James et al. (3) were considered and cited in the guideline. The third cited study by Pomp et al. (4) does not add any further data or aspects to the evidence-based conclusions/recommendations of the guideline and therefore does not meet the criteria for inclusion in the reference list as stipulated by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).
We wish to thank Teusch too, for his important comment regarding the literature on the prophylaxis of venous thromboembolism (VTE) in the setting of living kidney donation. Indeed, to date only one study has been reported that looked only at thromboprophylaxis in recipients, and which does not support the guideline’s recommendation to use prophylaxis in living donors (5). We will clarify this in the accompanying text to the long version of the guideline. However, the recommendation for medical prophylaxis in the setting of living kidney donation with regard to donors derives from the risk assessment for retroperitoneal surgery (nephrectomy) and the special importance of the endpoint patient safety in this situation. We therefore do not see any need for changing the recommendation for medical thromboprophylaxis in living donors.
Prof. Dr. med. Albrecht Encke
Prof. Dr. med. Sylvia Haas
Prof. Dr. med. Ina Kopp
AWMF-Institut für Medizinisches Wissensmanagement
Conflict of interest statement
Prof. Haas has received consultancy fees from Bayer, Bristol-Myers Squibb, Daiichi Sankyo, and Sanofi. She has received reimbursement of travel expenses and lecture fees from Aspen, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, and Sanofi.
Prof. Kopp and Prof. Encke declare that no conflict of interest exists.
|1.||Encke A, Haas S, Kopp I: Clinical practice guideline: The prophylaxis of venous thromboembolism. Dtsch Arztebl Int 2016; 113: 532–8 VOLLTEXT|
|2.||Heit JA, Kobbervig CE, James AH, et al.: Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. 3 rd. Ann Intern Med. 2005; 143: 697–706 CrossRef MEDLINE|
|3.||James A: Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 2009; 29: 326–31 CrossRef MEDLINE|
|4.||Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ: Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost 2008; 6: 632–37 CrossRef MEDLINE|
|5.||Osman Y, Kamal M, Soliman S, et al. Necessity of routine postoperative heparinization in non-risky live-donor renal transplantation: results of a prospective randomized trial. Urology 2007; 69 (4): 647 – 51 CrossRef MEDLINE|