Van der Pol L M, Mairuhu A T A, Tromeur C, Couturaud F, Huisman M V, Klok F A
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; Department of Vascular Medicine, Haga hospital, The Hague, The Netherlands.
Department of Vascular Medicine, Haga hospital, The Hague, The Netherlands.
Blood Rev. 2017 Mar;31(2):31-36. doi: 10.1016/j.blre.2016.09.003. Epub 2016 Sep 29.
Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy. Consequently, clinical guidelines provide contradicting and weak recommendations on this subject and the optimal diagnostic strategy remains highly debated. With this systematic review, we aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients.
由于孕妇发生静脉血栓栓塞（VTE）的风险增加，同时正常妊娠会出现一些症状，类似于急性肺栓塞（PE）的症状，因此这类患者常被怀疑患有后者。由于影像学检查会使母亲和胎儿暴露于电离辐射下，基于非放射学诊断测试排除PE的能力至关重要。然而，临床决策规则在疑似PE的孕妇群体中仅得到很少的评估，而由于正常妊娠期间D-二聚体水平会生理性升高，其诊断准确性会降低。因此，临床指南在这个问题上提供的建议相互矛盾且力度不足，最佳诊断策略仍存在激烈争议。通过这项系统评价，我们旨在总结当前关于临床决策规则和生物标志物在疑似急性PE的孕妇诊断管理中的安全性和有效性的证据。
