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Differences of computed tomography pulmonary angiography versus ventilation-perfusion lung scan in pregnant patients with suspected acute pulmonary embolism are not well-known, leading to ongoing debate on which test to choose. We searched in PUBMED, EMBASE, Web of science and Cochrane library databases and identified all relevant articles and abstracts published up to October1st 2017. We assessed diagnostic efficiency, frequency of non-diagnostic results and radiation exposure for patient and fetus. We included 13 studies for the diagnostic efficiency analysis, 30 for non-diagnostic results analysis and 22 for radiation exposure analysis. Pooled rate of false negative test results was 0% for both imaging strategies with overlapping confidence intervals. The pooled rate of non-diagnostic results with computed tomography pulmonary angiography and ventilation-perfusion lung scan were 12% (95%CI 8-17) and 14% (95%CI 10-18), respectively. Reported maternal and fetal radiation exposure doses were well below the safety threshold, but could not be compared between computed tomography pulmonary angiography and ventilation-perfusion lung scan given the lack of high quality data. Both imaging tests seem equally safe to rule out PE in pregnancy. We found no significant differences in efficiency and radiation exposures between computed tomography pulmonary angiography and ventilation-perfusion lung scan although direct comparisons were not possible. .

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In 1998 we estimated the incidence of venous thromboembolism (VTE) to be 1.8/1,000 per year. The aim of this study was to compare current VTE incidence to that observed in 1998. We prospectively recorded all cases of symptomatic pulmonary embolism (PE) and deep vein thrombosis (DVT) of the lower limbs diagnosed between March 1, 2013 and February 28, 2014 in hospitals and in the community, using the same method and geographic area than in 1998. The 2013 incidence rates of VTE were computed and compared with those of 1998 using age- and sex-specific standardised incidence ratios (SIRs). In 2013, we recorded 576 VTE cases (279 isolated DVT and 297 PE ± DVT). Among 367,911 inhabitants, the overall incidence of VTE was 1.57/1,000 (95 % CI 1.44-1.69). The overall VTE incidence was significantly lower in 2013 as compared with 1998: SIR 0.72 (95 % CI 0.67-0.79) as well as the incidence of isolated DVT: SIR 0.53 (95 % CI 0.47-0.60); conversely, the overall incidence of PE was unchanged: SIR 1.10 (95 % CI, 0.98-1.23) despite an increase in the incidence of isolated PE: SIR 1.29 (95 % CI, 1.10-1.52). In 1998, 4.4 % of PE cases were diagnosed using CTPA as compared with 73.7 % in 2013 (p < 0.001). In conclusion, between 1998 and 2013, the incidence of symptomatic DVT decreased. Conversely, we found no similar reduction in the incidence of symptomatic PE; whether this is due to changes in diagnostic tests and algorithms in the management of suspected PE requires further investigations.

We aimed to identify risk factors for recurrent venous thromboembolism (VTE) after unprovoked pulmonary embolism.Analyses were based on the double-blind randomised PADIS-PE trial, which included 371 patients with a first unprovoked pulmonary embolism initially treated during 6 months who were randomised to receive an additional 18 months of warfarin or placebo and followed up for 2 years after study treatment discontinuation. All patients had ventilation/perfusion lung scan at inclusion ( at 6 months of anticoagulation).During a median follow-up of 41 months, recurrent VTE occurred in 67 out of 371 patients (6.8 events per 100 person-years). In main multivariate analysis, the hazard ratio for recurrence was 3.65 (95% CI 1.33-9.99) for age 50-65 years, 4.70 (95% CI 1.78-12.40) for age >65 years, 2.06 (95% CI 1.14-3.72) for patients with pulmonary vascular obstruction index (PVOI) ≥5% at 6 months and 2.38 (95% CI 1.15-4.89) for patients with antiphospholipid antibodies. When considering that PVOI at 6 months would not be available in practice, PVOI ≥40% at pulmonary embolism diagnosis (present in 40% of patients) was also associated with a 2-fold increased risk of recurrence.After a first unprovoked pulmonary embolism, age, PVOI at pulmonary embolism diagnosis or after 6 months of anticoagulation and antiphospholipid antibodies were found to be independent predictors for recurrence.

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