New cut-off point for D-dimer in the diagnosis of pulmonary embolism during pregnancy

Abstract

Background: Considering that pulmonary embolism (PE) is one of the leading causes of mortality among pregnant women and that the D-dimer level in pregnancy can be highly fluctuating, a new and reliable Ddimer reference value is essential to identifying PE in this group of patients. Hence, the present study aimed to evaluate the diagnostic effect of D-dimer testing in pregnant women with suspected PE.Methods: This study recruited 100 women with confirmed pregnancy or six weeks after delivery or abortion with suspected PE symptoms. Wells criteria, D-dimer values, and pregnancy trimesters were recorded. Definitive PE results were obtained using multidetector computed tomography (MDCT) or pulmonary ventilation/perfusion scans.Results: D-dimer cut-off point in PE diagnosis was higher than 1,447 µg/L [sensitivity, 87.5%; specificity, 63.04%; area under the curve (AUC)=0.735; P=0.003]. In addition, the combination of Wells criteria with the D-dimer test indicated that the cut-off points of D-dimer in PE likely and unlikely women were 1,962 and 1,447 μg/L, respectively, and had acceptable and significant diagnostic value in PE detection. In addition, the diagnostic value of D-dimer in pregnancy trimesters was not found to be significant (P>0.05). Conclusion:The new cut-off points of 1,447 and 1,962 μg/L were determined for D-dimer in pregnant women with likely and unlikely PE, respectively. Moreover, the new cut-off points in the first and second trimesters of pregnancy were 1,701 μg/L and 1,451 μg/L, respectively, which indicated no statistically acceptable diagnostic value.

Pregnancy-adapted YEARS Algorithm: A Retrospective Analysis

“…Literature suggests that D-dimer values fluctuate during pregnancy, and its use alone is not sufficient in ruling out a PE regardless of trimester. 3 , 7 The third patient was a 28-year-old woman in her third trimester with a D-dimer of 1.48 mg/L with no YEARS criteria. The evaluating physician decided the patient had unspecified dyspnea of unclear origin and ruled that CTPA was not necessary.…”

“…Pulmonary embolism remains a significant cause of maternal mortality. 1 – 3 Studies show that approximately 9% of pregnancy-related deaths in the United States are due to a PE. 2 Causes include physiologic changes in pregnancy that induce a hypercoagulable state, which predisposes patients to venous thromboembolism (VTE).…”

“…D-dimer testing, widely used in non-pregnant patients, is controversial in pregnancy because its accuracy varies by trimester. 3 , 7 Proposals for age-adjusted or trimester-adjusted cut-off values have been or are currently being considered. 8 – 10 …”

“…Pulmonary embolism remains a significant cause of maternal mortality. [1][2][3] Studies show that approximately 9% of pregnancy-related deaths in the United States are due to a Western Journal of Emergency Medicine Volume 25, No. 1: January 2024 136 PE.…”

“…D-dimer testing, widely used in non-pregnant patients, is controversial in pregnancy because its accuracy varies by trimester. 3,7 Proposals for ageadjusted or trimester-adjusted cut-off values have been or are currently being considered. [8][9][10] Reports show that the prevalence of PE in pregnant patients undergoing diagnostic workup in the emergency department (ED) is approximately 3.7%, whereas nonpregnant patients of childbearing age showing a PE prevalence of 6.0%.…”