Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data
| Autor: | Stals, M.A.M., Moumneh, T., Ainle, F.N., Aujesky, D., Bemmel, T. van, Bertoletti, L., Bistervels, I.M., Chauleur, C., Couturaud, F., Dooren, Y.P.A. van, Elias, A., Faber, L.M., Gall, C., Hofstee, H.M.A., Hulle, T. van der, Kruip, M.J.H.A., Maignan, M., Mairuhu, A.T.A., Middeldorp, S., Moigne, E. Le, Nijkeuter, M., Pol, L. van de, Robert-Ebadi, H., Roy, P.M., Sanchez, O., Schmidt, J., Smeden, M. van, Tromeur, C., Wolde, M.T., Righini, M., Gal, G. Le, Huisman, M.V., Klok, F.A. |
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| Přispěvatelé: | Hematology, Graduate School, Vascular Medicine, ACS - Pulmonary hypertension & thrombosis, Amsterdam Reproduction & Development (AR&D) |
| Rok vydání: | 2023 |
| Předmět: | |
| Zdroj: | Journal of Thrombosis and Haemostasis, 21, 3, pp. 606-615 Journal of thrombosis and haemostasis : JTH, 21(3), 606-615. Wiley-Blackwell Publishing Ltd Journal of thrombosis and haemostasis : JTH, 21(3), 606-615. Wiley-Blackwell Journal of Thrombosis and Haemostasis, 21, 606-615 |
| ISSN: | 1538-7933 |
| Popis: | Item does not contain fulltext 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. |
| Databáze: | OpenAIRE |
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