Details

Autor(en) / Beteiligte

• 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
• Nijkeuter, Mathilde
• van der Pol, Liselotte M.
• Robert-Ebadi, Helia
• Roy, Pierre-Marie
• Sanchez, Olivier
• Schmidt, Jeannot
• van Smeden, Maarten
• Tromeur, Cecile
• Wolde, Marije ten
• Righini, Marc
• Le Gal, Grégoire
• Huisman, Menno V.
• Klok, Frederikus A.

Titel

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

Ist Teil von

• Journal of thrombosis and haemostasis, 2023-03, Vol.21 (3), p.606-615

Ort / Verlag

England: Elsevier Inc

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• Few studies evaluated the performance of noninvasive diagnostic strategies for suspected acute pulmonary embolism (PE) in pregnant women. 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. 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. 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). 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. •Few studies evaluated diagnostic strategies in pregnant women with suspected pulmonary embolism.•We performed an individual patient data meta-analysis to evaluate these strategies in pregnancy.•Both the Wells rule as the YEARS algorithm could safely rule out pulmonary embolism in pregnancy.•However, efficiency improved considerably when applying adapted (higher) D-dimer thresholds.•The efficiency of bilateral ultrasonography in patients without signs of deep-vein thrombosis was very low.