Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT‐PE‐pregnancy study

Langlois, Emilie; Cusson-Dufour, Camille; Moumneh, Thomas; Elias, Antoine; Meyer, Guy; Lacut, Karine; Schmidt, Jeannot; Gall, Catherine Le; Chauleur, Céline; Glauser, Frédéric; Robert‐Ebadi, Helia; Righini, Marc; Gal, Grégoire Le

doi:10.1111/jth.14483

Cited by 39 publications

(39 citation statements)

References 18 publications

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“…Using this approach, 39% of women were able to avoid diagnostic imaging, with an acceptably low three month venous thromboembolism incidence of 0.21% (0.04% to 1.2%). Furthermore, post hoc retrospective application of this pregnancy adapted YEARS algorithm to the cohort of patients in the first study showed similar findings, with 21% of women meeting criteria for exclusion of pulmonary embolism without diagnostic imaging and no venous thromboembolism events during follow-up 52. Limitations of these studies include relative small sample sizes and possible bias for inclusion of patients at lower risk.…”

Section: Diagnosismentioning

confidence: 62%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

137

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Pulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

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Section: Diagnosismentioning

confidence: 62%

Pulmonary embolism: update on management and controversies

Duffett

Castellucci

Forgie

2020

BMJ

137

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“…None of these women had PE diagnosed during the initial workup or 3-month follow-up, for a failure rate of the pregnancy-adapted YEARS algorithm of 0% (95% CI, 0.0-3.9%). 73 At present, the pregnancy-adapted YEARS algorithm is the best validated method for diagnosing and excluding PE in pregnancy.…”

Section: No Datamentioning

confidence: 99%

Pulmonary Embolism in Pregnancy

Bates

2021

Semin Respir Crit Care Med

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Even though venous thromboembolism is a leading cause of maternal mortality in high-income countries, there are limited high-quality data to assist clinicians with the management of pulmonary embolism in this patient population. Diagnosis, prevention, and treatment of pregnancy-associated pulmonary embolism are complicated by the need to consider fetal, as well as maternal, well-being. Recent studies suggest that clinical prediction rules and D-dimer testing can reduce the need for diagnostic imaging in a subset of patients. Low-molecular-weight heparin is the preferred anticoagulant for both prophylaxis and treatment in this setting. Direct oral anticoagulants are contraindicated during pregnancy and in breastfeeding women. Thrombolysis or embolectomy should be considered for pregnant women with pulmonary embolism complicated by hemodynamic instability. Treatment of pregnancy-associated pulmonary embolism should be continued for at least 3 months, including 6 weeks postpartum. Management of anticoagulants at the time of delivery should involve a multidisciplinary individualized approach that uses shared decision making to take patient and caregiver values and preferences into account.

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“…A post hoc analysis of the previously mentioned Swiss-French prospective management study 31 assessed the accuracy and safety of the pregnancyadapted YEARS algorithm in women with suspected PE. 12 Also in this analysis, the algorithm proved to be well tolerated with no VTE occurring during follow up (0%, 95% CI 0-3.9).…”

Section: Diagnostic Management Of Vte In Pregnant Patientsmentioning

confidence: 99%

Contemporary best practice in the management of pulmonary embolism during pregnancy

Wiegers

2020

Ther Adv Respir Dis

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Approximately 1–2 per 1000 pregnancies are complicated by venous thromboembolism (VTE). VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and the diagnostic management of pregnancy-related VTE is challenging. Current guidelines vary greatly in their approach to diagnosing PE in pregnancy as they base their recommendations on scarce and weak evidence. The pregnancy-adapted YEARS diagnostic algorithm is well tolerated and is the most efficient diagnostic algorithm for pregnant women with suspected PE, with 39% of women not requiring computed tomographic pulmonary angiography. Low-molecular-weight heparin is the first-choice anticoagulant treatment in pregnancy and should be continued until 6 weeks postpartum and for a minimum of 3 months. Direct oral anticoagulants should be avoided in women who want to breastfeed. Management of delivery needs a multidisciplinary approach in order to decide on an optimal delivery plan. Neuraxial analgesia can be given in most patients, provided time windows since last low-molecular-weight heparin dose are respected. Women with a history of VTE are at risk of recurrence during pregnancy and in the postpartum period. Therefore, in most women with a history of VTE, thromboprophylaxis in subsequent pregnancies is indicated. The reviews of this paper are available via the supplemental material section.

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Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT‐PE‐pregnancy study

Cited by 39 publications

References 18 publications

Pulmonary embolism: update on management and controversies

Pulmonary embolism: update on management and controversies

Pulmonary Embolism in Pregnancy

Contemporary best practice in the management of pulmonary embolism during pregnancy

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