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4/2018
vol. 14
abstract:
Clinical research
Pregnancy as a predictor of deviations from the recommended diagnostic pathway in women with suspected pulmonary embolism: ZATPOL registry data
Anna Fijałkowska, Ewa Szczerba, Grzegorz Szewczyk, Anna Budaj-Fidecka, Janusz Burakowski, Bożena Sobkowicz, Alicja Nowowiejska-Wiewióra, Grzegorz Opolski, Adam Torbicki, Marcin Kurzyna, ZATPOL Registry Investigators
Arch Med Sci 2018; 14, 4: 838–845
Online publish date: 2017/10/20
Introduction
Pulmonary embolism (PE) is a leading cause of mortality in pregnancy and a great diagnostic challenge. Deviations from the recommended diagnostic pathway in suspected PE contribute to greater mortality in the general population. The deviations from the guidelines of the European Society of Cardiology (ESC) for diagnosis of PE were analyzed, with particular emphasis on pregnant women with suspected PE.
Material and methods
ZATPOL is a prospective national registry including data of all patients with suspected PE admitted to 86 Polish cardiology departments between January 2007 and September 2008. We analyzed diagnostic pathways used in all 2015 patients (mean age: 67 ±15 years, 60% women) with suspected PE. Detailed analysis included diagnostic pathways used in 12 pregnant patients and 85 non-pregnant women in childbearing age.
Results
Pregnancy was the strongest predictor of deviations from the recommended diagnostic pathway in the whole study group (HR = 4.0, 95% CI: 1.28–12.5, p = 0.02). Pregnant patients did not differ significantly from non-pregnant women in most risk factors and symptoms of PE, and diagnostic tests used in this condition. Deviations from the recommended diagnostic pathway were found in 7 (58%) and 36 (42%) pregnant and non-pregnant women, respectively (p = 0.297), and the preliminary diagnosis of PE was eventually confirmed in 42% and 67% of the patients, respectively (p = 0.086).
Conclusions
Despite the lack of significant differences in PE symptomatology in pregnant and non-pregnant women, pregnancy seems to be the strongest predictor of deviations from the diagnostic pathway recommended in PE by the ESC. Further studies are required to evaluate the adherence to current guidelines in pregnant women.
keywords:
pulmonary embolism, pregnancy, diagnosis, registry
references:
Konstantinides S, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3033-80.
Blanco-Molina A, Rota L, Di Micco P, et al. Venous thromboembolism during pregnancy, postpartum or during contraceptive use. Findings from the RIETE Registry. Thromb Haemost 2010; 103: 306-11.
Pollack CV, Schreiber D, Goldhaber SZ, et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 2011; 57: 700-6.
Stein PD, Beemath A, Matta F, et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9.
Kurzyna M. Ocena prawidłowości diagnostyki ostrej zatorowości płucnej i jej związku z rokowaniem pacjentów hospitalizowanych w ośrodkach kardiologicznych w Polsce. Analiza wyników Rejestru ZATPOL. Warszawa, Instytut Gruźlicy i Chorób Płuc 2010.
Budaj-Fidecka A, Kurzyna M, Fijałkowska A, et al. In-hospital major bleeding predicts mortality in patients with pulmonary embolism: an analysis of ZATPOL Registry data. Int J Cardiol 2013; 1013: 3543-9.
Torbicki A, Perrier A, Konstantinides S, et al. Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-315.
Thornburg KL, Jacobson SL, Giraud GD, et al. Hemodynamic changes in pregnancy. Semin Perinatol 2000; 24: 11-4.
Milne JA, Howie AD, Pack AI. Dyspnoea during normal pregnancy. Br J Obstet Gynaecol 1978; 85: 260-3.
Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report 2010; 26: 1-32.
James AH. Venous thromboembolism: mechanisms, treatment, and public awareness. Venous thromboembolism in pregnancy. Arterioscler Thromb Vasc Biol 2009; 29: 326-31.
Paczyńska M, Sobieraj P, Burzyński Ł, et al. Tricuspid annulus plane systolic excursion (TAPSE) has superior predictive value compared to right ventricular to left ventricular ratio in normotensive patients with acute pulmonary embolism. Arch Med Sci 2016; 12: 1008-14.
Regitz-Zagrosek V, Lundqvist CB, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J 2011; 32: 3147-97.
Linnemann B, Bauersachs R, Rott H, et al. Diagnosis of pregnancy-associated venous thromboembolism – position paper of the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH). Vasa 2016; 45: 87-101.
Leung AN, Bull TM, Jaeschke R, et al.; the ATS/STR Committee on Pulmonary Embolism in Pregnancy. An Official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. Am J Respir Crit Care Med 2011; 184: 1200-8.
Tromeura C, van der Pol LM, Klok FA, Couturaud F, Huismana MV. Pitfalls in the diagnostic management of pulmonary embolism in pregnancy. Thromb Res 2017; 151 Suppl. 1: S86-91.
Kline JA, Richardson DM, Than MP, et al. Systematic review and meta-analysis of pregnant patients investigated for suspected pulmonary embolism in the emergency department. Acad Emerg Med 2014; 21: 949-59.
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