Academic Journal
The diagnostic performance of the YEARS and Pulmonary Embolism Graduated D-dimer algorithms in patients with prior venous thrombosis suspected of pulmonary embolism.
| Τίτλος: | The diagnostic performance of the YEARS and Pulmonary Embolism Graduated D-dimer algorithms in patients with prior venous thrombosis suspected of pulmonary embolism. |
|---|---|
| Συγγραφείς: | Martens ESL; Division of Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands., Mai V; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Bates V; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Delluc A; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Girard P; Département de Pneumologie, Institut Mutualiste Montsouris, Paris, France.; French Clinical Research Infrastructure Network INvestigation Network On Venous Thrombo-Embolism Network, Saint-Etienne, France., Huisman MV; Division of Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands., Kahn SR; Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada., Kearon C; Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada., Kovacs MJ; Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada., Pecarskie A; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Righini M; Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Rodger M; Department of Medicine, McGill University, McGill University Health Center, Montreal, Quebec, Canada., Scarvelis D; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Schulman S; Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada., Shivakumar S; Department of Medicine, Dalhousie University, Nova Scotia Health, Halifax, Nova Scotia, Canada., Tan M; Department of Medicine, Hospital Gelderse Vallei, Ede, Netherlands., Thiruganasambandamoorthy V; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada., Visser S; Department of Emergency Medicine, Hôpital Montfort, Ottawa, Ontario, Canada., Wells PS; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Le Gal G; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada., Klok FA; Division of Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, Netherlands. |
| Πηγή: | Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2026 Apr 30; Vol. 10 (4), pp. 106617. Date of Electronic Publication: 2026 Apr 30 (Print Publication: 2026). |
| Τύπος έκδοσης: | Journal Article; Multicenter Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: United States NLM ID: 101703775 Publication Model: eCollection Cited Medium: Internet ISSN: 2475-0379 (Electronic) Linking ISSN: 24750379 NLM ISO Abbreviation: Res Pract Thromb Haemost Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : [New York] : Elsevier Original Publication: Hoboken, NJ : John Wiley & Sons, Inc., [2017]- |
| Ιατρικοί όροι (MeSH): | Fibrin Fibrinogen Degradation Products*/analysis , Pulmonary Embolism*/diagnosis , Pulmonary Embolism*/blood , Pulmonary Embolism*/epidemiology , Venous Thromboembolism*/blood , Venous Thromboembolism*/diagnosis , Venous Thromboembolism*/epidemiology , Venous Thrombosis*/diagnosis , Venous Thrombosis*/blood , Venous Thrombosis*/complications , Venous Thrombosis*/epidemiology , Algorithms*, Anticoagulants/therapeutic use ; Biomarkers/blood ; Aged ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Recurrence ; Time Factors |
| Περίληψη: | Background: Evidence on how diagnostic algorithms perform in patients with prior venous thromboembolism (VTE) is scarce. Objectives: This study determined the diagnostic miss rate during 3-month follow-up and the proportion of avoided imaging using the YEARS and Pulmonary Embolism Graduated D-dimer (PEGeD) algorithms. Methods: This preplanned analysis was part of the international prospective multicenter PREDICTORS study that included outpatients suspected of recurrent VTE managed with validated diagnostic algorithms and D-dimer assays per local practices. Clinical variables were collected to compute the original Wells, modified Wells, and revised Geneva scores. Patients without VTE were followed up for 3 months. Events were independently adjudicated. For this analysis, YEARS and PEGeD scores were computed post hoc for patients with suspected pulmonary embolism (PE). Results: In total, 188 patients were included. Overall, PE incidence at baseline was 31% (58/188), and 47% (47/99) in those without anticoagulation. Applying YEARS, 87 patients (46%) would have had PE ruled out without imaging. The overall diagnostic miss rate would have been 2 of 83 (2.4%; 95% CI, 0.7%-8.4%) and 2 of 29 (6.9%; 95% CI, 1.9%-22%) in those without anticoagulation: both patients had no YEARS items and D-dimer of <1000 ng/mL but had imaging at baseline showing PE. For PEGeD, these numbers were 80 (43%) for efficiency, with an associated diagnostic miss rate of 2 of 77 (2.6%; 95% CI, 0.7%-9.0%) and 2 of 26 (7.7%; 95% CI, 2.1%-24%) in those without anticoagulation: both patients had a Wells score of <4.5 and D-dimer of <1000 ng/mL but had imaging at baseline showing PE. Conclusion: Both diagnostic algorithms showed comparable safety and efficiency in patients with prior VTE. Notably, the diagnostic miss rate was higher than expected and exceeded the safety margin. (© 2026 The Author(s).) |
| Contributed Indexing: | Keywords: clinical decision rules; diagnosis; pulmonary embolism; venous thrombosis |
| Substance Nomenclature: | 0 (Anticoagulants) 0 (Biomarkers) 0 (Fibrin Fibrinogen Degradation Products) 0 (fibrin fragment D) |
| Entry Date(s): | Date Created: 20260615 Date Completed: 20260615 Latest Revision: 20260624 |
| Update Code: | 20260625 |
| PubMed Central ID: | PMC13264360 |
| DOI: | 10.1016/j.rpth.2026.106617 |
| PMID: | 42293738 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2475-0379 |
|---|---|
| DOI: | 10.1016/j.rpth.2026.106617 |