Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands

Abstract

A potential link between mortality, D-dimer values and a prothrombotic syndrome has been reported in patients with COVID-19 infection. The National Institute for Public Health of the Netherlands asked a group of Radiology and Vascular Medicine experts to provide guidance for the imaging workup and treatment of these important complications. This report summarizes evidence for thromboembolic disease, potential diagnostic and preventive actions as well as recommendations for patients with COVID-19 infection.

Arterial thromboembolic complications in COVID‐19 in low‐risk patients despite prophylaxis

“…9 In terms of preventing and treating venous thromboembolic disease there remains limited evidence or guidance from well-controlled trials on whether low-molecular-weight heparin, unfractionated heparin, direct factor Xa inhibitors, direct thrombin inhibition or other approaches are optimal. 10…”

Chest CT features of the novel coronavirus disease (COVID-19)

“…The prevalence of thromboembolic events in patients with COVID-19 has been shown to increase compared to the healthy population. Therefore, when CT shows peripherally located, triangular-shaped consolidation areas, pulmonary thromboembolism, and infarction (Hampton hump) should be considered in the differential diagnosis [44,45].…”

“…Life-threatening thromboembolic events are increasingly identified in COVID-19 patients [44,45,47]. Recently, Grillet and colleagues [44] reported the prevalence of pulmonary embolism (PE) as 23% (n = 23/100) in COVID-19 patients with severe clinical features, and they reported that COVID-19 patients with PE, had a higher requirement for mechanical ventilation than those…”

“…Moreover, Leonard-Lorant et al[47] reported that 22 of 106 patients (30%) with COVID-19 had acute pulmonary thromboembolism. Elevated D-dimer levels have been frequently reported in COVID-19 cases, especially in COVID-19 patients with PE[5,45,47]. Current guidelines recommend performing unenhanced chest CT for COVID-19 suspected patients with risk factors and/or severe-critical clinical findings.…”

“…However, thromboembolic events associated with COVID-19 infection are not uncommon. Besides, especially those treated in the intensive care unit and patients in mechanical ventilation therapy are in the high-risk group for deep venous thrombosis and PE[44,45]. Therefore, pulmonary CT angiography is essential for evaluating lung parenchyma and vascular complications for COVID-19 cases with severe and/or critical clinical features and high D-dimer levels(Figures 6a, 6b, and 6c).…”