Abstract Number: PB2301
Meeting: ISTH 2020 Congress
Background: Few studies evaluated the safety of a predefined diagnostic algorithm starting with pre-test probability assessment and D-dimer testing to rule out acute pulmonary embolism (PE) in pregnant women. Hence, the diagnostic accuracy of non-invasive diagnostic tests to rule out PE can be further established.
Aims: To establish the safety and efficiency of pre-test probability assessment, D-dimer testing and compression ultrasonography (CUS) in pregnant women with suspected acute PE in an individual patient data meta-analysis (IPDMA).
Methods: We performed a systematic review of the literature to identify all prospective diagnostic management studies in pregnant women with suspected acute PE, in which pre-test probability and D-dimer testing was used to rule out PE without imaging. Patient level data of the identified studies was collected and analyzed. The primary outcome was the 3-month incidence of venous thromboembolism (VTE) in patients with non-high pre-test probability and normal D-dimer test, using the Wells rule or YEARS algorithm. Efficiency was defined as the number of patients in whom CTPA was avoided. We additionally studied the diagnostic performance of CUS.
Results: We identified only two relevant studies, which ruled out the possibility of a meta-analysis. Because we excluded study-specific clustering of relevant patient characteristics in a multivariate model, data of the two studies were analysed as a whole. The combined studies totalled 893 pregnant women (Table 1). The diagnostic accuracy and efficiency of the individual diagnostic tests applied in the studies are summarized in Table 2. The YEARS algorithm as well as the Wells rule combined with D-dimer testing safely ruled out PE. The efficiency of bilateral CUS was limited, foremost in patients without symptoms of deep vein thrombosis (DVT).
Conclusions: This study underlines current guideline recommendations (ESC 2019) to apply pre-test probability assessment and D-dimer tests to rule out PE in low risk pregnant women, reducing potential harmful imaging tests.
To cite this abstract in AMA style:Stals M, Moumneh T, Aujesky D, Bertoletti L, Bistervels I, Couturaud F, Elias A, Le Gal G, Huisman MV, Mairuhu ATA, Middeldorp S, van der Pol LM, Righini M, Robert-Ebadi H, Roy P-, Sanchez O, van Smeden M, Schmidt J, Tromeur C, Klok FA, on behalf of the CT-PE-Pregnancy Group and Artemis Investigators . A Non-invasive Diagnostic Work-up Is Safe and Efficient to Exclude Pulmonary Embolism in Low Risk Pregnant Women with Suspected Pulmonary Embolism: A Systematic Review and Meta-analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-non-invasive-diagnostic-work-up-is-safe-and-efficient-to-exclude-pulmonary-embolism-in-low-risk-pregnant-women-with-suspected-pulmonary-embolism-a-systematic-review-and-meta-analysis/. Accessed May 18, 2021.
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