en
Scientific article
Meta-analysis
English

Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy : a systematic review and meta-analysis of individual patient data

Published inJournal of thrombosis and haemostasis, vol. 21, no. 3, p. 606-615
Publication date2023-03
First online date2022-12-23
Abstract

Background: Few studies evaluated the performance of noninvasive diagnostic strategies for suspected acute pulmonary embolism (PE) in pregnant women.

Objectives: The aim of this study was to establish the safety and efficiency of the Wells rule with fixed and adapted D-dimer threshold, and the YEARS algorithm, combined with compression ultrasonography (CUS), in pregnant women with suspected PE in an individual patient data meta-analysis.

Methods: We performed a systematic review to identify prospective diagnostic management studies in pregnant women with suspected PE. Primary outcomes were safety, defined as the failure rate, ie, the 3-month venous thromboembolism (VTE) incidence after excluding PE without chest imaging, and efficiency, defined as the proportion of patients in whom chest imaging could be avoided.

Results: We identified 2 relevant studies, of which individual patient-level data were analyzed in a fixed-effect meta-analysis, totaling 893 pregnant women. The Wells rule with fixed and adapted D-dimer threshold as well as the YEARS algorithm could safely rule out acute PE (failure rate, 0·37%-1·4%), but efficiency improved considerably when applying pretest probability-adapted D-dimer thresholds. The efficiency of bilateral CUS was limited (2·3% overall; number needed to test 43), especially in patients without symptoms of deep-vein thrombosis (efficiency 0·79%; number needed to test 127).

Conclusion: This study supports the latest guideline recommendations (European Society of Cardiology 2019) to apply pretest probability assessment and D-dimer tests to rule out PE in pregnant women. From an efficiency perspective, the use of a strategy with pretest probability-adapted D-dimer threshold is preferred. The yield of CUS was very limited in patients without concomitant symptoms of deep-vein thrombosis.

eng
Keywords
  • D-dimer
  • Diagnosis
  • Pregnancy
  • Pulmonary embolism
  • Ultrasonography
Citation (ISO format)
STALS, Milou A M et al. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy : a systematic review and meta-analysis of individual patient data. In: Journal of thrombosis and haemostasis, 2023, vol. 21, n° 3, p. 606–615. doi: 10.1016/j.jtha.2022.11.025
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ISSN of the journal1538-7836
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