Algorithm safely rules out pulmonary embolism in pregnant women

Originally Published By 2 Minute Medicine®. Reused on Clinical Advisor with permission.
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1. A diagnostic model based on D-dimer measurement, lower limb compression ultrasonography (CUS) and computed tomography pulmonary angiography (CTPA) accurately ruled out pulmonary embolism (PE) in pregnancy.

2. No thromboembolic events occurred at the 3-month follow up for women with PE ruled out by the algorithm.

Evidence Rating Level: 2 (Good)

Study Rundown: During pregnancy, women have an increased risk of PE. It is one of the most common causes of maternal death in developed countries, and therefore it is an important diagnosis to make accurately. Currently, data on the best method of diagnostic management for PE in pregnant women is limited. The authors of this study, therefore, aimed to prospectively validate a diagnostic strategy developed to assess women in pregnancy with suspected PE. Based on their results, they concluded that the algorithm safely rules out PE in pregnant women. Study limitations included that there were several protocol deviations. Furthermore, the sample size was small; consequently, the study may not be generalizable to all populations of pregnant women.

Click to read the study in Annals of Internal Medicine

In-Depth [prospective cohort]: The authors conducted a multicenter, multinational, prospective diagnostic management outcome study. They utilized several factors, including pretest clinical probability assessment, high-sensitivity D-dimer testing, CUS and CTPA to rule out PE in pregnant women. A total of 11 centers in France and Switzerland were included in the study between August 2008 and July 2016. In total, 395 women met inclusion criteria for the study, with PE diagnosed in 28 (7.1%) of the study participants. The rate of symptomatic venous thromboembolic disease was 0.0% (95% CI, 0.0% to 1.0%) among the women that had PE ruled out through the diagnostic work-up and did not receive and anticoagulation treatment.

Image: PD

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