How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units

Abstract

Introduction The Coronavirus disease-2019 outbreak (COVID-19) has been declared a pandemic by the World Health Organization. Studies report both a severe inflammatory syndrome and a procoagulant state in severe COVID-19 cases, with an increase of venous thromboembolism, including pulmonary embolism (PE) and deep vein thrombosis (DVT). In this context, we discuss the use of doppler ultrasonography (DUS) in the screening and diagnosis of DVT in ambulatory and hospitalized patients with, or suspected of having, COVID-19, outside the intensive care unit (ICU). Material and methods Non-systematic review of the literature. Results In patients hospitalized for or suspected of COVID-19 infection with the presence of either (a) DVT clinical symptoms, (b) a strong DVT clinical probability (Wells score > 2) or (c) elevated D-dimer levels without DVT clinical symptoms and without PE on lung CT angio-scan, DVT should be investigated with DUS. In the presence of PE diagnosed clinically and/or radiologically, additional systematic DVT screening using DUS is not recommended during the COVID-19 pandemic. The use of 4-points compression DUS for DVT screen and diagnosis is the most appropriate method in this context. Discussion Systematic DUS for DVT screening in asymptomatic COVID patients is not recommended unless the patient is in the ICU. This would increase the risk of unnecessarily exposing medical staff to SARS-CoV-2 and monopolizing limited resources during this period.

Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study

“…Ultimately, our study did not put in evidence higher rate of VTE complications, which may be due to the small number of events in the COVID-19 population or the possibility that patients had early anticoagulant treatment when symptomatic. However, the potential importance of VTE associated with COVID-19 must not be neglected, especially in severe forms [ 27 , 28 ]. Notably, the risk could be potentiated in case of pregnancy.…”

The Relationship between Inflammatory Cytokines and Coagulopathy in Patients with COVID-19

“…Venous thromboembolism (VTE) events, deep vein thrombosis (DVT) and pulmonary embolism (PE) were recorded during their convalescence. Diagnostic strategy for venous thromboembolism was careful screening of patients’ clinical manifestations to determine signs and symptoms indicative of VTE including airway bleeding, pulmonary derangement and acute onset of unspecified tachycardia and hypotension, followed by the use of Doppler ultrasonography (DUS) of both lower extremities with the application of CT angiography especially in high-risk ambulatory patients with negative sonography [ 17 , 18 ]. All mortalities during the study period were recorded, as were the underlying risk factors.…”

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

“…In a normal lung, it is detectable horizontal repetitions of the pleural line as a reverberation artifact, the A-lines. The association of the A profile with phlebothrombosis favours the diagnosis of pulmonary embolism (PE) [ 111 ]. The main LUS findings in interstitial syndromes are B-lines [ 112 ].…”