Marta Bellesini1,2, Helia Robert-Ebadi1, Christophe Combescure3, Cristina Dedionigi2, Grégoire Le Gal4, Marc Righini1. 1. Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 2. Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese and Como, Italy. 3. Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland. 4. Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
Abstract
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 June 2021, 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 665 references through systematic database and additional search strategies; 45 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. CONCLUSION: Our results suggest that D-dimer allows to safely rule out VTE in pregnant women with suspected VTE and a disease prevalence consistent with a low/intermediate or unlikely pre-test probability. This article is protected by copyright. All rights reserved.
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 June 2021, 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 665 references through systematic database and additional search strategies; 45 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. CONCLUSION: Our results suggest that D-dimer allows to safely rule out VTE in pregnant women with suspected VTE and a disease prevalence consistent with a low/intermediate or unlikely pre-test probability. This article is protected by copyright. All rights reserved.
Authors: Claire Auditeau; Lina Khider; Benjamin Planquette; Olivier Sanchez; David M Smadja; Nicolas Gendron Journal: Res Pract Thromb Haemost Date: 2022-05-25