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-19epositive 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-19epositive patients. We recommend following the algorithms with the idea that as more data becomes available these algorithms may well change.

Bleeding and Bleeding Risk in COVID-19

“…27 Another study shows that thrombosis-and bleeding-predicting tools are useful in the management of patients. 28 The study assessed the potential usefulness of Padua prediction score-to predict thrombosis risk-and the improved bleed risk assessment model-to predict risk of bleeding-in COVID-19 patients under thromboprophylaxis with UFH and LMWH. According to the bleeding predicting tool, nine (6.5%) patients had a high risk of bleeding (improved score !…”

“…7), six of whom ($67%) experienced hemorrhagic events during the course of thromboprophylaxis, including mild or microscopic hematuria (n: 3), GI bleeding (n: 1), epistaxis (n: 1), and severe hemothorax (n: 1). 28 More detailed thromboprophylaxis of patients with COVID-19 and venous thromboembolism is outside the scope of this work and is presented elsewhere. 28 Anticoagulant therapy is contraindicated for patients with active bleeding and for those with a low platelet count (according to ISTH guidance < 25 Â 10 9 /L).…”

“…28 More detailed thromboprophylaxis of patients with COVID-19 and venous thromboembolism is outside the scope of this work and is presented elsewhere. 28 Anticoagulant therapy is contraindicated for patients with active bleeding and for those with a low platelet count (according to ISTH guidance < 25 Â 10 9 /L). 17 In COVID-19 patients under treatment with DOACs, the coadministration of antivirals significantly increased the plasma concentration of DOACs; the trough level of DOAC was 6.14 times higher during hospitalization than before admission.…”

Viscoelastic testing in COVID‐19: a possible screening tool for severe disease?

“…Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) causes coronavirus disease 2019 (COVID‐19) that manifests with variable severity 1 . A subset of symptomatic individuals develop proinflammatory or prothrombotic profiles requiring additional testing and interventions 2‐5 . It is unclear which COVID‐19 patients will ultimately develop severe disease that would have benefitted from early and aggressive interventions.…”

Podemos atuar preventivamente para evitar que os pacientes portadores de COVID-19 evoluam de forma mais grave?

“…2 Since there is no consensus-approved treatment in this situation and considering the possibility of thrombosis associated with infection by coronavirus in certain cases, recently-acquired experience and findings of still-embryonic scientific studies has shown that effective anticoagulation can prevent or reverse the prothrombotic state in some patients. 2,3…”