PB1530 - Diagnostic strategies in postpartum individuals with suspected venous thromboembolism: A scoping review

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Gurjeet S. Bhangu, MD (he/him/his)

Internal Medicine Resident
Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada

Co-Author(s)

AM

Alistair Murray

Hematology Fellow
Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
AQ

Areeb Qayyum

Research Assistant
Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
NG

Natasha Goumeniouk

Emergency Medicine Resident
Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
SG

Steve Goodacre

Professor of Emergency Medicine
School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
Sheffield, England, United Kingdom
Beverley J. Hunt, MD, FRCP, FRCPath

Professor of Thrombosis & Haemostasis, Consultant Haematologist
Guy's & St Thomas' NHS Foundation Trust
London, England, United Kingdom
OT

Omar Touhami

Gynecologist Oncologist
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Centre Intégré Universitaire de Santé et Services Sociaux CIUSSS du Saguenay-Lac-Saint-Jean, Sherbrooke University, QC, Canada
Sherbrooke, Quebec, Canada
JT

Jodie Tester

MD, BHSc, MWomHMed
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Melbourne, Victoria, Australia
DP

Diane Pascoe

MBBS, FRANZCR
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
Melbourne, Victoria, Australia
PR

Paul Ronksley

Associate Professor
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada
Gregoire Le Gal, MD PhD

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

Associate Professor
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, AB, Canada
Calgary, Alberta, Canada

Background: Venous thromboembolism (VTE: deep vein thrombosis [DVT] and pulmonary embolism [PE]) is increased in the postpartum period and remains one of the leading causes of maternal death. While there have been advances in evaluating diagnostic algorithms in pregnant individuals to diagnose VTE, there is limited data for postpartum individuals where many of the same diagnostic challenges exist.

Aims: We conducted a scoping review of published studies aiming to describe and evaluate diagnostic strategies used for the investigation of suspected VTE in postpartum individuals.

Methods: A systematic search strategy was conducted in OVID Medline, Embase and the Cochrane Central Register of Controlled Trials (2000-September 30, 2022) to identify original articles that reported on diagnostic strategies in postpartum individuals with suspected VTE. Two reviewers screened abstracts and relevant full-text reviews, and disagreements were resolved by consensus. We extracted demographic data, clinical prediction rules used, D-dimer and imaging completed including test performance, and VTE outcomes. Authors were contacted to obtain separate postpartum data.

Results: Our search yielded 3,534 unique abstracts, of which 152 underwent full-text review and 24 articles were identified. To date, we have separate postpartum data for 12 studies. The 12 studies were conducted across 11 countries and included a total of 3,113 participants, 732 of whom had separate postpartum data for suspected PE (n=607) or DVT (n=125). The use of a clinical prediction rule and/or D-dimer was studied in 118 and 117 postpartum participants, respectively. Among those with suspected PE, the most common diagnostic test ordered was a CTPA, with a PE positivity rate that ranged from 0% to 27.6% across studies.

Conclusion(s): There is heterogeneity in the diagnostic strategies used to investigate suspected VTE in postpartum individuals. Future prospective studies should aim to improve the postpartum diagnosis of VTE.