Risk Stratification and D-Dimer Can Safely Exclude Pulmonary Embolism in Pregnant Patients

Risk stratification tools for evaluation of patients with suspected pulmonary embolism (PE) include the PE Rule Out Criteria (PERC), Wells Score, Revised Geneva Score (RGS), age-adjusted D-dimer threshold, and YEARS algorithm. However, these tools have remained mostly untested in pregnant patients, a group at elevated risk for venous thromboembolic events. In fact, a 2017 review of international guidelines found that none recommended the use of risk stratification tools in pregnant patients. Furthermore, only one guideline recommended that a negative D-dimer could rule out PE in pregnant patients, while others explicitly recommended against use of the D-dimer level (Thromb Res 2017; 157:23). This lack of evidence left advanced imaging as th…