ORIGINAL ARTICLE
D‐dimer to rule out venous thromboembolism during pregnancy: A systematic review and meta‐analysis

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Abstract

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; I², 0%) and 100% for negative predictive value (95% CI, 99.19–100.0; I², 0%). The prevalence of VTE and the yield of D‐dimer were 7.4% (95% CI, 3.8–12; I², 83%) and 34.2% (95% CI, 15.9–55.23; I², 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.

Keywords

clinical probability
D‐dimer.
diagnostic strategy
pregnancy
pulmonary embolism

Cited by (0)

Marta Bellesini and Helia Robert‐Ebadi contributed equally to this work.

Manuscript handled by: Claire McLintock

Final decision: Claire McLintock, 22‐Jun‐2021

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.