Pitfalls in the diagnostic management of pulmonary embolism in pregnancy

Tromeur, Cécile; Pol, Liselotte M. van der; Klok, Frederikus A.; Couturaud, Francis; Huisman, Menno V.

doi:10.1016/s0049-3848(17)30075-0

Cited by 20 publications

(21 citation statements)

References 36 publications

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“…Both methods are at risk of inconclusive results, but among pregnant patients this probability is higher for angio-CT. However, in pregnant women with abnormal chest X-ray, the rate of nondiagnostic ventilation-perfusion scans is significantly higher [ 14 , 16 ]. There are two ongoing trials aimed at clarifying unsolved issues of the diagnostic pathway in pregnant women [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data

Fijałkowska

Szczerba

Szewczyk

et al. 2017

aoms

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IntroductionPulmonary embolism (PE) is a leading cause of mortality in pregnancy and a great diagnostic challenge. Deviations from the recommended diagnostic pathway in suspected PE contribute to greater mortality in the general population. The deviations from the guidelines of the European Society of Cardiology (ESC) for diagnosis of PE were analyzed, with particular emphasis on pregnant women with suspected PE.Material and methodsZATPOL is a prospective national registry including data of all patients with suspected PE admitted to 86 Polish cardiology departments between January 2007 and September 2008. We analyzed diagnostic pathways used in all 2015 patients (mean age: 67 ±15 years, 60% women) with suspected PE. Detailed analysis included diagnostic pathways used in 12 pregnant patients and 85 non-pregnant women in childbearing age.ResultsPregnancy was the strongest predictor of deviations from the recommended diagnostic pathway in the whole study group (HR = 4.0, 95% CI: 1.28–12.5, p = 0.02). Pregnant patients did not differ significantly from non-pregnant women in most risk factors and symptoms of PE, and diagnostic tests used in this condition. Deviations from the recommended diagnostic pathway were found in 7 (58%) and 36 (42%) pregnant and non-pregnant women, respectively (p = 0.297), and the preliminary diagnosis of PE was eventually confirmed in 42% and 67% of the patients, respectively (p = 0.086).ConclusionsDespite the lack of significant differences in PE symptomatology in pregnant and non-pregnant women, pregnancy seems to be the strongest predictor of deviations from the diagnostic pathway recommended in PE by the ESC. Further studies are required to evaluate the adherence to current guidelines in pregnant women.

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Section: Discussionmentioning

confidence: 99%

Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data

Fijałkowska

Szczerba

Szewczyk

et al. 2017

aoms

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“…Both maternal and fetal radiation exposure are low using modern imaging techniques (table 12) [385,[392][393][394][395][396][397][398]. For V/Q scans and CTPA, fetal radiation doses are well below the threshold associated with fetal radiation complications (which is 50-100 mSv) [399,400]. In the past, CTPA has been reported to cause high radiation exposure to the breast [395,401]; however, CT technology has evolved, and several techniques can now reduce radiation exposure without compromising image quality.…”

Section: Imaging Testsmentioning

confidence: 99%

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

et al. 2019

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“…Specific cutoffs to be used for pregnant women and children have also been proposed [106,122,123]. However, as Ddimer increases physiologically throughout pregnancy, the identification of an accurate D-dimer diagnostic threshold will be challenging [124]. The Diagnosis of PE in Pregnancy (DiPEP) biomarker study recently showed that no biomarker has diagnostic efficiency for diagnosing VTE in pregnancy or in the puerperium [125].…”

Section: D-dimer Unitsmentioning

confidence: 99%

“…In case of suspicion of PE, because imaging tests may expose the mother and the fetus to radiation, the ability to rule-out PE with non-radiologic tests is crucial [107]. To improve the usefulness of D-dimer results, specific cutoffs have been proposed, but not yet validated, in a large prospective study [124]. However, once again, a negative D-dimer result keeps its sensitivity and NPV [107].…”

Section: Vte Diagnosis In Specific Populationsmentioning

confidence: 99%

D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications

Favresse

Lippi

Roy

et al. 2018

Critical Reviews in Clinical Laboratory Sciences

134

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D-dimer is a soluble fibrin degradation product deriving from the plasmin-mediated degradation of cross-linked fibrin. D-dimer can hence be considered a biomarker of activation of coagulation and fibrinolysis, and it is routinely used for ruling out venous thromboembolism (VTE). D-dimer is increasingly used to assess the risk of VTE recurrence and to help define the optimal duration of anticoagulation treatment in patients with VTE, for diagnosing disseminated intravascular coagulation, and for screening medical patients at increased risk of VTE. This review is aimed at (1) revising the definition of D-dimer; (2) discussing preanalytical variables affecting the measurement of D-dimer; (3) reviewing and comparing assay performance and some postanalytical variables (e.g. different units and age-adjusted cutoffs); and (4) discussing the use of D-dimer measurement across different clinical settings.

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Pitfalls in the diagnostic management of pulmonary embolism in pregnancy

Cited by 20 publications

References 36 publications

Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data

Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications

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