Abstract Number: PB1309
Meeting: ISTH 2021 Congress
Background: PA-PE is a leading cause of maternal morbidity and mortality in the UK. The current assessment of PEs in pregnancy is difficult and unreliable, leading to the need for better diagnostic strategies. There is debate regarding whether an algorithm such as the pregnancy- adapted YEARS score (figure 1) can be helpful in order to simplify this diagnostic process; the algorithm has been subject to conflicting reports on its efficacy, especially considering the conclusions of the DiPEP biomarker study (2018) which showed no correlation between D-dimer and VTE in pregnancy.
Aims: The study aims to assess the utility of the YEARS algorithm in relation to PA-PE.
Methods: From a local data-base, women who had suffered a PA-PE and who had a D-dimer performed in pregnancy were identified and notes obtained. There were full sets of data available for 36 women. The pregnancy-adapted YEARS algorithm was applied retrospectively to assess its utility. The criteria are summarised in figure 1.
Results: A total of 36 cases of PA-PE were identified, of which 23 were antenatal and 13 were postnatal events. The YEARS score was 1-3 in all cases. D-dimer was raised above the threshold in all but 2 cases (520-9,530ng/ml). CTPA or V/Q scans were performed and PE confirmed in 30 cases and no PE in 4 cases. Two women had d dimer below the threshold and on CTPA did not have a PE. (Table 1)
|YEARS-predicted||Proven PE||PE not found|
|36||30 (89%)||4 (11%)|
|23 (64%)||13 (36%)|
|CTPA/VQ||Presence of PE||No PE present|
|30 (89%)||4 (11%)|
Conclusions: No PEs were missed but the score predicted presence of PE in 11 % of cases which had negative scans. These were antenatally suspected VTEs in all four cases. It is reassuring that no VTEs were missed but the specificity of the algorithm is low as dependent on the experience of the assessor as to whether PE is ‘the most likely diagnosis’.
To cite this abstract in AMA style:Alexander A, Treharne E, jackson E, Myers B. Assessment of the Utility of the Pregnancy-adapted YEARS Algorithm in Predicting Presence of Pulmonary Embolism (PE) in Pregnant Women (PA-PE) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/assessment-of-the-utility-of-the-pregnancy-adapted-years-algorithm-in-predicting-presence-of-pulmonary-embolism-pe-in-pregnant-women-pa-pe/. Accessed September 24, 2021.
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