COVID-19 and venous thromboembolism: Known and unknown for imaging decisions

Abstract

As we continue to fight against the current coronavirus disease-2019 (COVID-19) pandemic, healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination. Since early in the pandemic, studies indicated a heightened risk of venous thromboembolism (VTE) in COVID-19 infected patients. There have been differing expert opinions about how to assess pretest probability of VTE in this patient population. This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE. Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough. Some have argued for more routine screening at different points of care. Others have even suggested empiric therapeutic anti-coagulation in moderate to severely ill COVID-19 patients. In the following article, we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients. We also discuss research gaps and share pathways currently being used within our institution.

Long-term chest CT follow-up in COVID-19 Survivors: 102–361 days after onset

“…These parameters showed significant differences between survivors with and without dyspnea, similar to results obtained in SARS survivors (22,24). D2-polymer is frequently elevated in acute venous thromboembolism (VTE) but is nonspecific, being frequently elevated in many other nonthrombotic conditions, including pregnancy, cancer and inflammation, and it has been shown to be frequently elevated in COVID-19-positive patients in the absence of VTE (28). In our study, 67.4% of the survivors had an elevated peak D2-polymer level during hospitalization, but no cases of pulmonary embolism were confirmed during hospitalization, and only 3 patients were readmitted for pulmonary embolism within 5-7 months after discharge.…”

The Role of POCUS to Face COVID-19: A Narrative Review

“…Even if screening of deep venous thrombosis (DVT) was not routinely recommended, during COVID-19 infection, D-dimer conventional values were a less reliable marker to assess thromboembolism as higher values were found irrespective of its presence [62]. Thus, an extensive use of POCUS was implemented, especially in those with sever hemodynamic worsening [63]. A case report reported how the BLUE protocol was integrated with a focused echocardiography to permit a stronger diagnosis in suspected pulmonary embolism in a case of COVID-19 with a normal lung ultrasound [64].…”

Outcomes in patients discharged with extended venous thromboembolism prophylaxis after hospitalization with COVID-19

“…9 Owing to challenges associated with timely diagnosis of VTE, risk stratification and appropriate VTE prophylaxis became even more important in COVID-19 patients. 10 Early in the pandemic, when studies were lacking regarding how best to care for patients with COVID-19, many health systems developed institutional expert committees to provide clinical guidance. At our health system, institutional experts formed a COVID Clinical Content Group in April 2020, which provided guidance on key clinical questions regarding the care of patients with COVID-19.…”

“…9 Owing to challenges associated with timely diagnosis of VTE, risk stratification and appropriate VTE prophylaxis became even more important in COVID-19 patients. 10…”