Skip to main content
ISTH 2023 Main banner
Back

    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB1008 - The diagnostic performance of the YEARS and PEGeD algorithm in patients with prior venous thrombosis suspected of pulmonary embolism

    Monday, June 26, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • Emily S.L Martens, MD/PhD-student

      Leiden University Medical Center
      Leiden, Zuid-Holland, Netherlands

      • Co-Author(s)

    • Vicky Mai, MD MSc (she/her/hers)

      MD, MSc
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
      Ottawa, Ontario, Canada

    • VB

      Veronica Bates

      BSc
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
      Ottawa, Ontario, Canada

    • AD

      Aurélien Delluc

      Professor, MD, PhD
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
      Ottawa, Ontario, Canada

    • PG

      Philippe Girard

      MD
      Département Thoracique, Institut Mutualiste Montsouris; Paris, FCRIN INNOVTE, France.
      Paris, Ile-de-France, France

    • MH

      Menno V. Huisman

      MD, PhD
      Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
      Leiden, Zuid-Holland, Netherlands

    • SK

      Susan R. Kahn

      MD, MSc
      McGill University, Montreal, QC, Canada
      Montreal, Quebec, Canada

    • MK

      Michael J. Kovacs

      MD
      Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
      London, Ontario, Canada

    • AP

      Amanda Pecarskie

      BSc
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
      Ottawa, Ontario, Canada

    • Marc Righini, MD

      MD
      Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
      Geneve, Geneve, Switzerland

    • Marc A. Rodger, MD (he/him/his)

      Professor
      Department of Medicine, McGill University, McGill University Health Center, Montreal, Quebec, Canada
      Montreal, Quebec, Canada

    • DS

      Dimitrios Scarvelis

      MD
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
      Ottawa, Ontario, Canada

    • Sam Schulman, MD, PhD

      MD, PhD
      Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
      Hamilton, Ontario, Canada

    • SS

      Sudeep Shivakumar

      MD
      Department of Medicine, Dalhousie University, Nova Scotia Health, Halifax, Nova Scotia, Canada.
      Halifax, Nova Scotia, Canada

    • MT

      Melanie Tan

      MD, PhD
      Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
      Utrecht, Utrecht, Netherlands

    • VT

      Venkatesh Thiruganasambandamoorthy

      MD, MSc
      University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada.
      Ottawa, Ontario, Canada

    • SV

      Shaun Visser

      MD
      Department of Emergency Medicine, Hôpital Montfort, Ottawa, Ontario, Canada.
      Ottawa, Ontario, Canada

    • PW

      Philip S. Wells

      MD, MSc
      Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
      Ottawa, Ontario, Canada

    • Gregoire Le Gal, MD PhD

      MD, PhD
      Ottawa Hospital Research Institute, University of Ottawa, Canada
      Ottawa, Ontario, Canada

    • Erik Klok, MD, PhD, FESC

      Leiden University Medical Center

    Background: Evidence on how diagnostic algorithms perform in patients with prior venous thromboembolism (VTE) is scarce.

    Aims: Determine the diagnostic miss-rate during 3-month follow-up and the proportion of avoided imaging of the YEARS and PEGeD.

    Methods: This is a post-hoc analysis of the international prospective multicenter PREDICTORS study in outpatients suspected of recurrent VTE, managed by validated diagnostic algorithms and D-dimer assays according to local practices. Clinical variables to compute the original Wells, modified Wells and revised Geneva score were collected in each individual. After initial testing, follow-up was three months for those without VTE. VTE were independently adjudicated. For current analysis, YEARS and PEGeD scores were computed post-hoc in patient with suspected recurrent PE (rPE), with or without deep vein thrombosis suspicion, and only VIDAS D-dimer results were used.

    Results: One hundred eighty-eight patients were included. The overall PE prevalence at baseline was 31% (58/188), and in those without anticoagulation 47% (47/99). When YEARS would have been applied, 87 patients (46%) would have had PE ruled out without imaging. The overall diagnostic miss-rate in those without indication for imaging would have been 2/85 (2.4%, 95% confidence interval (CI) 0.6-8.2), and 2/31 (6.5%, 95%CI 1.8-20.7) in those without anticoagulation at baseline: both patients had no YEARS-items and D-dimer < 1000ng/mL but had been subjected to imaging for suspected rPE at baseline showing PE. For PEGeD, these numbers were 80 (43%) for efficiency with an associated diagnostic miss-rate of 2/79 (2.5%, 95%CI 0.7-8.8), and 2/28 (7.1%, 95%CI 2.0-22.7) in those without anticoagulation at baseline: both patients had a Wells-score below 4.5 and D-dimer < 1000ng/mL but had been subjected to imaging tests for suspected rPE at baseline showing PE.

    Conclusion(s): Overall, both diagnostic algorithms showed comparable safety and efficiency in patients with prior VTE. The diagnostic miss-rate was higher than expected and exceeded the safety margin.