Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism

Abstract Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Si...

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Bibliographic Details
Published in:Blood reviews 2017-03, Vol.31 (2), p.31-36
Main Authors: Van der Pol, L.M, Mairuhu, A.T.A, Tromeur, C, Couturaud, F, Huisman, M.V, Klok, F.A
Format: Article
Language:English
Subjects:
Algorithms
Biomarkers
Blood Coagulation Tests
Cardiology and cardiovascular system
D-dimer
Decision rule
Decision Support Techniques
Female
Fibrin Fibrinogen Degradation Products
Hematology, Oncology and Palliative Medicine
Human health and pathology
Humans
Life Sciences
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications, Hematologic - blood
Pregnancy Complications, Hematologic - diagnosis
Pregnancy Complications, Hematologic - etiology
Prognosis
Pulmonary embolism
Pulmonary Embolism - blood
Pulmonary Embolism - diagnosis
Pulmonary Embolism - etiology
Venous thromboembolism
Venous Thromboembolism - blood
Venous Thromboembolism - diagnosis
Venous Thromboembolism - etiology
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Summary:Abstract Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy. Consequently, clinical guidelines provide contradicting and weak recommendations on this subject and the optimal diagnostic strategy remains highly debated. With this systematic review, we aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients.
ISSN:0268-960X
1532-1681
DOI:10.1016/j.blre.2016.09.003