D- Dimer a safe diagnostic test to rule out VTE during pregnancy, finds study

Venous thromboembolism (VTE) is a leading cause of death and disability worldwide. The risk of VTE is higher in pregnant women and a leading cause of maternal death in western countries. A recent study by Marta Bellesini and their team evaluated the safety of D- Dimer as a diagnostic tool in pregnant women. The study is published in the journal of thrombosis and hemostasis.

The objective of the study was to investigate the safety of D- Dimer as a diagnostic tool in pregnant women to rule out VTE with suspected pulmonary embolism and deep vein thrombosis.

The study had two reviewers independently identify studies through PubMed and Embase until the first week of June 2021. They strengthened the study 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 considered eligible.

Researchers identified 665 references through a systematic database and additional search strategies, out of which 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.

The researchers concluded that "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." The D-dimer can be used to safely rule out acute VTE in pregnant women without a high pre-test probability for VTE.

For further information: https://doi.org/10.1111/jth.15432.