Practical diagnosis and treatment of suspected venous thromboembolism during COVID-19 pandemic

Abstract

A markedly increased demand for vascular ultrasound laboratory and other imaging studies in COVID-19-positive patients has occurred, due to most of these patients having a markedly elevated D-dimer and a presumed prothrombotic state in many of the very ill patients. In the present report, we have summarized a broad institutional consensus focusing on evaluation and recommended empirical therapy for COVID-19-positive patients. We recommend following the algorithms with the idea that as more data becomes available these algorithms may well change.

Keywords: Anticoagulant; Deep venous thrombosis; Duplex ultrasonography; Pulmonary embolism; Venous thromboembolism.

Fig 1

Algorithm for stable patient with suspected pulmonary embolism (PE). AC, anticoagulation; CT, computed tomography; D/C, discharge; DOAC, direct-acting oral anticoagulant; Dx, diagnosis; LE, lower extremity; LMWH, low-molecular-weight heparin; Pt., patient; UFH, unfractionated heparin; VTE, venous thromboembolism.

Fig 2

Algorithm for critically ill patient with suspected pulmonary embolism (PE). AC, anticoagulation; Dx, diagnosis; LE, lower extremity; Pt., patient; VTE, venous thromboembolism.

Fig 3

Algorithm for stable patient with suspected deep venous thrombosis (DVT). AC, anticoagulation; D/C, discharge; DOAC, direct-acting oral anticoagulant; Dx, diagnosis; LE, lower extremity; LMWH, low-molecular-weight heparin; Pt., patient; UFH, unfractionated heparin; VTE, venous thromboembolism.

Fig 4

Algorithm for critically ill patient with suspected deep venous thromboembolism (DVT). AC, anticoagulation; ACS, acute coronary syndrome; AF, atrial fibrillation; Dx, diagnosis; LE, lower extremity; PE, pulmonary embolism; Pt., patient; VTE, venous thromboembolism.