Stals, Milou A M; Moumneh, Thomas; Ainle, Fionnuala Ni; Aujesky, Drahomir; van Bemmel, Thomas; Bertoletti, Laurent; Bistervels, Ingrid M; Chauleur, Céline; Couturaud, Francis; van Dooren, Yordi P A; Elias, Antoine; Faber, Laura M; Le Gall, Catherine; Hofstee, Herman M A; van der Hulle, Tom; Kruip, Marieke J H A; Maignan, Maxime; Mairuhu, Albert T A; Middeldorp, Saskia; Le Moigne, Emmanuelle; ... (2023). Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. Journal of thrombosis and haemostasis, 21(3), pp. 606-615. Wiley-Blackwell 10.1016/j.jtha.2022.11.025
Full text not available from this repository. (Request a copy)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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine |
UniBE Contributor: |
Aujesky, Drahomir |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1538-7836 |
Publisher: |
Wiley-Blackwell |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
26 Jan 2023 12:17 |
Last Modified: |
03 Mar 2023 00:15 |
Publisher DOI: |
10.1016/j.jtha.2022.11.025 |
PubMed ID: |
36696189 |
Uncontrolled Keywords: |
D-dimer diagnosis pregnancy pulmonary embolism ultrasonography |
URI: |
https://boris.unibe.ch/id/eprint/177903 |
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