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Current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy

Report by: Sivanthi Sivandarajah, Specialty Trainee in Emergency Medicine

Search checked by: Daniel Horner, ST4 in Emergency Medicine

Institution: Manchester Royal Infirmary, Manchester, UK

Clinical scenario

A patient attends the emergency department (ED) with atraumatic pleuritic chest pain. She is 12 weeks pregnant with no other medical history. A junior doctor has dutifully followed the ED guideline, noted that the patient is at ‘low clinical risk’ of pulmonary embolism (PE) and requested a D-dimer level, which has returned within normal limits. The junior doctor is now keen to discharge the patient, who has remained well in the ED, but wants to ‘run it by you’ first. You are surprised by the normal D-dimer level in pregnancy but wonder whether the sensitivity and negative predictive values are as high in pregnant patients as they are in low risk non-pregnant patients.

Three-part question

In [a clinically well pregnant patient with a suspected pulmonary embolism] is [a negative D-dimer] sufficiently sensitive to [exclude PE]?

Search strategy

Medline 1950–23rd November 2010) and Embase (1980–2nd November 2010) via NHS Evidence (http://www.library.nhs.uk/). The Cochrane Library, 23rd November 2010. MEDLINE and EMBASE: (exp pulmonary embolism/OR exp venous thromboembolism/OR venous thromboembolism.mp. OR pulmonary embolism.mp.) AND (exp pregnant women/OR exp …

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