Performance of a diagnostic algorithm based on a prediction rule, D-dimer and CT-scan for pulmonary embolism in patients with previous venous thromboembolism

Maria José Fabiá Valls; Tom van der Hulle; Paul L. den Exter; Inge C. M. Mos; Menno V. Huisman; Frederikus A. Klok

doi:10.1160/TH14-06-0488

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2015; 113(02): 406-413
DOI: 10.1160/TH14-06-0488

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Performance of a diagnostic algorithm based on a prediction rule, D-dimer and CT-scan for pulmonary embolism in patients with previous venous thromboembolism

A systematic review and meta-analysis

Maria José Fabiá Valls^*

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

²Department of Internal Medicine, Clinical University Hospital of Valencia, Valencia, Spain

,

Tom van der Hulle^*

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

,

Paul L. den Exter

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

,

Inge C. M. Mos

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

,

Menno V. Huisman

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

,

Frederikus A. Klok

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

› Institutsangaben

Abstract

Summary

Diagnostic management of suspected pulmonary embolism (PE) in patients with a history of venous thromboembolism (VTE) is complicateddue to persistent abnormal D-dimer levels, residual embolic obstruction and higher clinical prediction rule (CPR) scores. We aimed to evaluate the safety and efficiency of the standard diagnostic algorithm consisting of a CPR, D-dimer test and computed tomography pulmonary angiography (CTPA) in this specific patient category. We performed a systematic literature search for prospective studies evaluating a diagnostic algorithm in consecutive patients with clinically suspected PE and a history of VTE. The VTE incidence rates during three-month follow-up and the number of indicated CTPAs were pooled using random effect models. Four studies concerning 1,286 patients were included with a pooled baseline PE prevalence of 36 % (95 % confidence interval [CI] 30–42). In only 217 patients (15 %; 95 %CI 11–20) PE could be excluded without CTPA. The three-month VTE incidence rate was 0.8 % (95 %CI 0.06–2.4) in patients managed without CTPA, 1.6 % (95 %CI 0.3–4.0) in patients in whom PE was excluded by CTPA and 1.4 % (95 %CI 0.6–2.7) overall. In the pooled studies, PE was safely excluded in patients with a history of VTE based on a CPR followed by a D-dimer test and/or CTPA, although the efficiency of the algorithm is relatively low compared to patients without a history of VTE.

Keywords

Pulmonary embolism - diagnosis - D-dimer - multidetector computed tomography - safety - meta-analysis

Volltext

Referenzen

References
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