A Safe Way to Diagnose Prenatal Pulmonary Embolism

Researchers have validated a diagnostic strategy in pregnant women with suspected pulmonary embolism (PE). 

The study included 395 pregnant women with clinically suspected PE between August 2008 and July 2016 at 11 centers in France and Switzerland. Women with an intermediate or low pretest clinical probability and a negative D-dimer result were considered negative for PE. Remaining patients underwent lower limb compression ultrasonography (CUS); if CUS yielded negative results, they underwent computed tomography pulmonary angiography (CTPA). Inconclusive CTPA results were validated using a ventilation-perfusion (V/Q) scan. Patients who did not receive treatment were followed up after three months. 

Algorithm Validated for Pulmonary Embolism Diagnosis in Pregnancy https://t.co/BHRgDvKsU7@mencardio @jstragazue @apoleo @torresviera @igormorr @drjarayg @recetario1 @DrPontecarlosi @gonzaeperez @emartinezgmg @lugocastle @drsaavedra

— Sandra (@sandrapaulinarg) October 24, 2018

Of the 395 patients, 28 (7.1%) were diagnosed with PE (proximal deep venous thrombosis found on ultrasound [n = 7], positive CTPA result [n = 19], and high-probability V/Q scan [n = 2]). PE was excluded in 367 women (clinical probability and negative D-dimer result [n = 46], negative CTPA result [n = 290], normal or low-probability V/Q scan [n = 17], and other reason [n = 14]). During follow-up, 22 women, who primarily had previous venous thromboembolic disease, received extended anticoagulation. 

Diagnosis of #Pulmonary Embolism During #Pregnancy: Study shows diagnostic strategy based on assessment of clinical probability, D-dimer measurement, CUS, and CTPA can safely rule out PE in pregnant women. ⁦@ACPinternists⁩ ⁦@ACEPNow⁩ #FOAMed https://t.co/PErQmddXzV

— Marilyn Heine (@MarilynHeineMD) October 23, 2018

After three months, the untreated women had a symptomatic venous thromboembolic events rate of 0.0% (95% CI, 0.0% to 1.0%), which “meets the criteria recently proposed by the International Society on Thrombosis and Haemostasis for confirming the safety of VTE diagnostic strategies,” said the study authors. 

Useful paper! @Echoraljpangio @LaurentBertole1 @AJeunesMedVasc @ClubVasculaire @mmonrealriete Diagnosis of Pulmonary Embolism During Pregnancy | Ann Intern Med | ACP | https://t.co/O56r4AqWNM

— Alessandra BURA RIVIERE (@alebura) October 23, 2018

The researchers suggested that further research “focus on increasing the yield of noninvasive testing, such as by developing a specific clinical decision rule for suspected PE during pregnancy or using pregnancy-adapted D-dimer cutoff values.” 

Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry 

Exposure to Beta-Blockers in Early Pregnancy May Not Pose Large Cardiac Risks 

Depressive symptoms and comorbid problems in pregnancy – results from a population based study 

Sources: Annals of Internal Medicine, MedPage Today