Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19
By Denise Baez
NEW YORK -- April 24, 2020 - A special report published in the journal Radiology outlines prevention, diagnosis and treatment of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19).
Based on recent reports that demonstrated a strong association between elevated D-dimer levels and poor prognosis, concerns about thrombotic complications in patients with COVID-19 have arisen. 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. Their report summarises evidence for thromboembolic disease and potential diagnostic and preventive actions that can be taken.
“Worldwide, COVID-19 is being treated as a primary pulmonary disease,” said Edwin J.R. van Beek, MD, Queens Medical Research Institute, the University of Edinburgh, Edinburgh, United Kingdom. “From the analysis of all available current medical, laboratory, and imaging data on COVID-19, it became clear that symptoms and diagnostic tests could not be explained by impaired pulmonary ventilation alone.”
Recent observations suggest that respiratory failure in COVID-19 is not driven by the development of acute respiratory distress syndrome alone, but that microvascular thrombotic processes may play a role. This may have important consequences for the diagnostic and therapeutic management of these patients. There is a strong association between D-dimer levels, disease progression, and chest CT features suggesting venous thrombosis. In addition, various studies in patients with COVID-19 have shown a very strong association between increased D-dimer levels and severe disease/poor prognosis.
The authors stressed that careful attention needs to be paid to the initial diagnosis and treatment of the prothrombotic and thrombotic state that can occur in a substantial percentage of patients with COVID-19.
“Imaging and pathological investigations confirmed the COVID-19 syndrome is a thrombo-inflammatory process that initially affects lung perfusion, but consecutively affects all organs of the body,” said Dr. van Beek. “This highly thrombotic syndrome leads to macro-thrombosis and embolism. Therefore, strict thrombosis prophylaxis, close laboratory monitoring, and appropriate imaging monitoring, with early anticoagulant therapy in case of suspected venous thromboembolism, are indicated.”
Recommendations for diagnostic and therapeutic management, which vary based on patient symptoms and risk profiles, include prophylactic-dose heparin, chest CT, CT pulmonary angiography, and routine D-dimer testing.
“COVID-19 is more than a lung infection,” said Dr. van Beek. “It affects the vasculature of the lungs and other organs and has a high thrombosis risk with acute life-threatening events that require adequate treatment with anticoagulants based on laboratory monitoring with appropriate imaging tests as required.”