New cut-off point for D-dimer in the diagnosis of pulmonary embolism during pregnancy
Somayeh Sadeghi, Marjan Golshani, Bahareh Safaeian
Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Correspondence to: Bahareh Safaeian, M.D.
Department of Internal Medicine, Medical School, Isfahan University of Medical Sciences, Hezar Jerib street,
Isfahan 8174673461, Iran
E-mail: b_s_508@yahoo.com
Published online: August 12, 2021.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Considering that pulmonary embolism (PE) is one of the leading causes of mortality among pregnant women and that the D-dimer level in pregnancy can be highly fluctuating, a new and reliable Ddimer reference value is essential to identifying PE in this group of patients. Hence, the present study aimed to evaluate the diagnostic effect of D-dimer testing in pregnant women with suspected PE.
Methods: This study recruited 100 women with confirmed pregnancy or six weeks after delivery or abortion with suspected PE symptoms. Wells criteria, D-dimer values, and pregnancy trimesters were recorded. Definitive PE results were obtained using multidetector computed tomography (MDCT) or pulmonary ventilation/perfusion scans.
Results: D-dimer cut-off point in PE diagnosis was higher than 1,447 μg/L [sensitivity, 87.5%; specificity, 63.04%; area under the curve (AUC)=0.735; P=0.003]. In addition, the combination of Wells criteria with the D-dimer test indicated that the cut-off points of D-dimer in PE likely and unlikely women were 1,962 and 1,447 μg/L, respectively, and had acceptable and significant diagnostic value in PE detection. In addition, the diagnostic value of D-dimer in pregnancy trimesters was not found to be significant (P>0.05).
Conclusion: The new cut-off points of 1,447 and 1,962 μg/L were determined for D-dimer in pregnant women with likely and unlikely PE, respectively. Moreover, the new cut-off points in the first and second trimesters of pregnancy were 1,701 μg/L and 1,451 μg/L, respectively, which indicated no statistically acceptable diagnostic value.
Keywords: D-dimer, Pregnancy, Pulmonary embolism, Clinical decision rule


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