Il D-dimero nell’esclusione del tromboembolismo venoso nella donna in gravidanza: stato dell’arte
D-dimer in the exclusion of venous thromboembolism in pregnant women: state of the art

AUTORI

ABSTRACT

D-dimer in the exclusion of venous thromboembolism in pregnant women: state of the art

The diagnosis of pulmonary embolism (PE) in non-pregnant patients with suspected PE, relies on diagnostic strategies based on sequential assessment of clinical pre-test probability (PTP), determination of plasma D-dimer (DD) levels and diagnostic management: computed tomographic pulmonary angiography (CTPA), pulmonary ventilation/perfusion (V/Q SCAN) and compression ultrasonography (CUS). In pregnant women the use of conventional algorithms for PE is limited by several factors: pregnant women were not included in the studies that derived models assessing PPT of PE, normal pregnancy causes a progressive increase in circulating DD and finally DD levels often exceed non pregnant[1]validated cut-off points, being likely to produce more false positive results. Therefore, guidelines advice against the use of DD determination in pregnancy and recommend to proceed directly to diagnostic imaging. Nevertheless, the clinical presentation of PE can be confused with features of a healthy pregnancy and the prevalence of PE is lower than in non-pregnant population. This leads to a high proportion of negative diagnostic imaging findings. The most recent European Society of Cardiology guidelines, on the basis of two important studies (CT-PE-Pregnancy, ARTEMIS), recognize a possible role of the DD to rule out PE during pregnancy with stratification according PTP and a negative DD result. In the two studies, however, different clinical algorithms and different cut-offs for the DD are used. DD may be a useful diagnostic tool in the management of pregnant women with suspected PE, but further trials are needed to derive and validate models assessing PTP and to identify the optimal DD cut offs during pregnancy.

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