title: Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism.
abstract: Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy. Consequently, clinical guidelines provide contradicting and weak recommendations on this subject and the optimal diagnostic strategy remains highly debated. With this systematic review, we aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients.
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; Department of Vascular Medicine, Haga hospital, The Hague, The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Van der Pol
authors.affiliation: Department of Vascular Medicine, Haga hospital, The Hague, The Netherlands.
authors.forename: A T A
authors.initials: AT
authors.lastname: Mairuhu
authors.affiliation: Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.
authors.forename: C
authors.initials: C
authors.lastname: Tromeur
authors.affiliation: Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.
authors.forename: F
authors.initials: F
authors.lastname: Couturaud
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M V
authors.initials: MV
authors.lastname: Huisman
authors.affiliation: Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: f.a.klok@LUMC.nl.
authors.forename: F A
authors.initials: FA
authors.lastname: Klok
mesh_terms: D000465:Algorithms; D015415:Biomarkers; D001780:Blood Coagulation Tests; D003661:Decision Support Techniques; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-dimer; Decision rule; Fibrin fibrinogen degradation products; Pregnancy; Pulmonary embolism; Venous thromboembolism