Campbell Aidan R, Florio Cole J, Heringer Grace V, Woldemariam Sara T, Casey Scott D, Stubblefield William B, Westafer Lauren M, Qiao Edward, Middleton Cydney E, Zekar Lara, Gupta Nachiketa, Somers Madeline J, Reed Mary E, Roubinian Nareg H, Pai Ashok P, Sperling Jeffrey D, Vinson David R
Kaiser Permanente CREST Network, Pleasanton, California, USA.
Department of Microbiology and Molecular Genetics, University of California, Davis, California, USA.
Res Pract Thromb Haemost. 2025 Jan 31;9(1):102695. doi: 10.1016/j.rpth.2025.102695. eCollection 2025 Jan.
Society recommendations for preemptive (or empiric) anticoagulation during antenatal pulmonary embolism (PE) diagnostics rely on expert opinion, which varies widely across guidelines. The American College of Chest Physicians (CHEST), for example, recommends preemptive anticoagulation when PE is highly suspected or when a delay in imaging is anticipated. The American College of Obstetricians and Gynecologists, however, makes no mention of preemptive anticoagulation for suspected PE in their practice bulletin on thromboembolism in pregnancy. Patterns of preemptive anticoagulation in pregnancy are unknown.
To describe the prevalence of and CHEST-based eligibility for preemptive anticoagulation in pregnancy.
This retrospective cohort study was undertaken across 21 United States community hospitals from October 1, 2021 through March 30, 2023. We included pregnant adults without COVID-19 undergoing definitive diagnostic PE imaging. We used pregnancy-adapted Geneva scores to calculate pretest probability as a proxy for suspicion.
We included 326 patients: median age, 31.0 years; 51% were in the third trimester. Diagnostic settings included emergency departments ( = 254; 78%), Labor & Delivery ( = 65; 20%), and outpatient clinics ( = 7; 2%). Median time from emergency department computed tomography order to results was 1.40 hours (IQR: 0.78, 2.06). Prevalence of confirmed or presumed PE was low ( = 8; 2.5%). Only 2 patients (0.6%) received preemptive anticoagulation, whereas by CHEST criteria, 34 patients (10.4%) were eligible.
We found rare use of preemptive anticoagulation during antenatal PE diagnostics in this imaged cohort with low PE prevalence and rapid access to diagnostic imaging. More research is needed to explore setting-specific variation in preemptive anticoagulation use.
关于产前肺栓塞（PE）诊断期间进行预防性（或经验性）抗凝的社会建议依赖于专家意见，而这些意见在不同指南中差异很大。例如，美国胸科医师学会（CHEST）建议在高度怀疑PE或预计影像学检查延迟时进行预防性抗凝。然而，美国妇产科医师学会在其关于妊娠期血栓栓塞的实践公告中并未提及对疑似PE进行预防性抗凝。妊娠期预防性抗凝的模式尚不清楚。
描述妊娠期预防性抗凝的患病率以及基于CHEST标准的适用情况。
本回顾性队列研究于2021年10月1日至2023年3月30日在美国21家社区医院进行。我们纳入了未感染新冠病毒且正在接受确定性诊断性PE影像学检查的成年孕妇。我们使用适用于妊娠的日内瓦评分来计算预检概率，作为怀疑程度的替代指标。
我们纳入了326例患者：中位年龄为31.0岁；51%处于孕晚期。诊断场所包括急诊科（n = 254；78%）、分娩室（n = 65；20%）和门诊诊所（n = 7；2%）。从急诊科计算机断层扫描医嘱到结果的中位时间为1.40小时（IQR：0.78，2.06）。确诊或疑似PE的患病率较低（n = 8；2.5%）。只有2例患者（0.6%）接受了预防性抗凝，而根据CHEST标准，34例患者（10.4%）符合条件。
在这个PE患病率低且能快速获得诊断性影像学检查的队列中，我们发现在产前PE诊断期间很少使用预防性抗凝。需要更多研究来探讨预防性抗凝使用的特定场所差异。
