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D‐dimer to rule out venous thromboembolism during pregnancy: A systematic review and meta‐analysis
Author(s) -
Bellesini Marta,
RobertEbadi Helia,
Combescure Christophe,
Dedionigi Cristina,
Le Gal Grégoire,
Righini Marc
Publication year - 2021
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.15432
Subject(s) - meta analysis , venous thromboembolism , d dimer , medicine , pregnancy , venous thrombosis , obstetrics , thrombosis , genetics , biology
Background The usefulness of D‐dimer measurement to rule out venous thromboembolism (VTE) during pregnancy is debated. Objectives We performed a systematic review and meta‐analysis to investigate the safety of D‐dimer to rule out acute VTE in pregnant women with suspected pulmonary embolism and/or deep vein thrombosis. Methods Two reviewers independently identified studies through PubMed and Embase until June 2021, week 1. We supplemented our search by manually reviewing reference lists of all retrieved articles, clinicalTrials.gov, and reference literature. Prospective or retrospective studies in which a formal diagnostic algorithm was used to evaluate the ability of D‐dimer to rule out VTE during pregnancy were eligible. Results We identified 665 references through systematic database and additional search strategies; 45 studies were retrieved in full, of which four were included, after applying exclusion criteria. Three studies were prospective, and one had a retrospective design. The 3‐month thromboembolic rate in pregnant women left untreated after a negative D‐dimer was 1/312 (0.32%; 95% CI, 0.06–1.83). The pooled estimate values were 99.5% for sensitivity (95% CI, 95.0–100.0; I ², 0%) and 100% for negative predictive value (95% CI, 99.19–100.0; I ², 0%). The prevalence of VTE and the yield of D‐dimer were 7.4% (95% CI, 3.8–12; I ², 83%) and 34.2% (95% CI, 15.9–55.23; I ², 89%) respectively. Conclusion Our results suggest that D‐dimer allows to safely rule out VTE in pregnant women with suspected VTE and a disease prevalence consistent with a low/intermediate or unlikely pretest probability.