Background: The usefulness of D-dimer measurement to rule out venous thromboembolism (VTE) during pregnancy is debated.

Aims: We performed a systematic review and meta-analysis to investigate the safety of D-dimer to rule out acute VTE in pregnant women with suspected pulmonary embolism (PE) and/or deep vein thrombosis (DVT).

Methods: Two reviewers independently identified studies through Pubmed and Embase until February 2020, Week 1. We supplemented our search by manually reviewing reference lists of all retrieved articles, clinicalTrials.gov and reference literature. Prospective or retrospective studies in which a formal diagnostic algorithm was used to evaluate the ability of D-dimer to rule out VTE during pregnancy were eligible.

Results: We identified 576 references through systematic database and additional search strategies; 41 studies were retrieved in full, of which four were included, after applying exclusion criteria. Three studies were prospective, and one had a retrospective design. The three-month thromboembolic rate in pregnant women left untreated after a negative D-dimer was 1/312 (0.32%; 95% CI, 0.06-1.83). The pooled estimate values were 99.5% for sensitivity (95% CI, 95.0-100.0; I², 0%) and 100% for negative predictive value (95% CI, 99.19-100.0; I², 0%). The prevalence of VTE and the yield of D-dimer were 7.4% (95% CI, 3.8-12; I², 83%) and 34.2% (95% CI, 15.9-55.23; I², 89%) respectively.

Conclusions: Our results suggest that D-dimer allows to safely rule out VTE in pregnant women with suspected VTE at low-intermediate pretest probability. However, data are limited, and further trials are needed to refine the optimal management strategy in this setting.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/d-dimer-to-rule-out-venous-thromboembolism-during-pregnancy-a-systematic-review-and-meta-analysis/