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

Autor:	Stals MAM; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Moumneh T; Department of Emergency Medicine, CHU Angers, University Hospital of Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, Angers, France; F-CRIN INNOVTE research network, Saint-Etienne, France., Ainle FN; Department of Hematology, Mater Misericordiae University Hospital, Dublin, and School of Medicine, University College Dublin, Ireland., Aujesky D; Division of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland., van Bemmel T; Department of Internal Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, the Netherlands., Bertoletti L; F-CRIN INNOVTE research network, Saint-Etienne, France; Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France; CIC 1408 Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France University Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM U 1059, Saint-Etienne, France., Bistervels IM; Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Chauleur C; Department of Obstetrics and Gynaecology, CHU de St-Etienne, Saint-Etienne, France; CIC 1408 Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France University Jean Monnet, University Hospital of Saint-Etienne, Mines Saint-Etienne, INSERM U 1059, Saint-Etienne, France., Couturaud F; F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France., van Dooren YPA; Department of Pulmonology, Groene Hart Hospital, Gouda, the Netherlands., Elias A; F-CRIN INNOVTE research network, Saint-Etienne, France; Médecine Vasculaire, Centre Hospitalier de Toulon, Toulon, France., Faber LM; Department of Internal Medicine, Red Cross Hospital, Beverwijk, the Netherlands., Le Gall C; F-CRIN INNOVTE research network, Saint-Etienne, France; Centre Hospitalier d'Argenteuil, Argenteuil, France., Hofstee HMA; Department of Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands., van der Hulle T; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Kruip MJHA; Department of Hematology Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands., Maignan M; Department of Emergency, CHU Grenoble-Alpes, Hypoxy-Physiopathology laboratory HP2, Grenoble, France., Mairuhu ATA; Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands., Middeldorp S; Department of Internal Medicine and Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands., Le Moigne E; F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France., Nijkeuter M; Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands., van der Pol LM; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Robert-Ebadi H; F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Medicine, Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Roy PM; Department of Emergency Medicine, CHU Angers, University Hospital of Angers, UMR MitoVasc CNRS 6015 - INSERM 1083, Equipe CARME, Angers, France; F-CRIN INNOVTE research network, Saint-Etienne, France., Sanchez O; F-CRIN INNOVTE research network, Saint-Etienne, France; Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France., Schmidt J; F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Emergency, CHU de Clermont-Ferrand, Clermont-Ferrand, France., van Smeden M; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Tromeur C; F-CRIN INNOVTE research network, Saint-Etienne, France; Department of Internal Medicine and Chest Diseases, Brest Hospital Center, Groupe d'Etude de Thrombose de Bretagne Occidentale, INSERM UMR1304, University of Brest, Brest, France., Wolde MT; Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands., Righini M; Department of Medicine, Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Le Gal G; Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada., Huisman MV; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Klok FA; Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.
Jazyk:	angličtina
Zdroj:	Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2023 Mar; Vol. 21 (3), pp. 606-615. Date of Electronic Publication: 2022 Dec 22.
DOI:	10.1016/j.jtha.2022.11.025
Abstrakt:	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. (Copyright © 2022 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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