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MONDAY, Oct. 22, 2018 (HealthDay News) — A diagnostic strategy based on pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower-limb compression ultrasonography (CUS), and computed tomography pulmonary angiography (CTPA) can safely rule out pulmonary embolism (PE) in pregnant women, according to a study published online Oct. 23 in the Annals of Internal Medicine<\/i>.<\/p>\n
Marc Righini, M.D., from Geneva University Hospitals, and colleagues conducted a prospective diagnostic management outcome study involving pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower-limb CUS, and CTPA. A total of 441 pregnant women with clinically suspected PE from 11 centers in France and Switzerland were assessed for eligibility, and 395 were included in the study.<\/p>\n
The researchers found that PE was diagnosed in 28 women (7.1 percent; proximal deep venous thrombosis found on ultrasound, positive CTPA, and high probability ventilation\/perfusion [V\/Q] scan) and was excluded in 367 women (clinical probability and negative D-dimer result, negative CTPA result, normal or low-probability V\/Q scan, and other reasons). During follow-up, 22 women received extended anticoagulation, mainly for previous venous thromboembolic disease. After exclusion of PE on the basis of negative results on the diagnostic work-up, the rate of symptomatic venous thromboembolic events was 0.0 percent among untreated women.<\/p>\n
“Future research should 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 cut-off values,” the authors write.<\/p>\n
Several authors disclosed financial ties to the biopharmaceutical industries.<\/p>\n
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