Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19 Patients

A recent report published in Radiology highlights accumulated knowledge of the imaging workup for COVID-19 patients, as well as the potential link between D-dimer values and a prothrombotic syndrome in those patients.

The National Institute for Public Health of the Netherlands asked a group of radiology practitioners and researchers from the Netherlands to compile a special report on the prevention, diagnosis, and treatment of certain complications that arise from COVID-19 such as blood clots and other thrombotic complications. The report lays out and summarizes the evidence gathered so far for the evidence of thromboembolic disease and for the potential diagnostic and preventive actions practitioners can take for their patients.

“Worldwide, COVID-19 is being treated as a primary pulmonary disease,” said Edwin J.R. van Beek, MD, PhD, director at Edinburgh Imaging, Queens Medical Research Institute, at the University of Edinburgh, UK, said in a press release. “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.”

The report noted that there are currently no publications on the prevalence of venous thromboembolism available, but that there have been case reports on thromboembolic disease, stroke, and myocarditis in COVID-19 patients. A single-center study of 183 COVID-19 patients from China showed that of 21 non-survivors, 15 (71%) had overt disseminated intravascular coagulation. With some recent evidence emerging pointing to microvascular thrombotic processes having a role to play outside of acute respiratory distress syndrome, the researchers also noted associations between elevated D-dimer levels (a degradation product of cross-linked fibrin that indicates blood clot formation) and severe disease/poor prognosis in COVID-19 patients.

The authors also highlighted potential preventive actions that could be taken, such as the prophylactic use of heparin, which in one study of 449 patients was associated with a reduction in 28-day mortality in some of those patients with a sepsis-induced coagulopathy score of four or greater. Efforts to standardize chest CT scan reporting were also recommended. The authors also recommended patients with suspected COVID-19 should receive CT pulmonary angiography if D-dimer levels are elevated, with routine D-dimer testing during any hospitalization.

“Careful attention needs to be paid to the initial diagnosis, prevention and treatment of the prothrombotic and thrombotic state that can occur in a substantial percentage of COVID-19 patients,” the authors concluded.

RADIOLOGY New: Thromboembolic complications in #COVID19, potential link between mortality, D-dimer values and a prothrombotic syndrome. https://t.co/PjwU0k2bJW #radiology @radiology_rsna pic.twitter.com/Y61NozazWI

— @RadiologyEditor (@RadiologyEditor) April 23, 2020

D-dimer is a degradation product of cross-linked fibrin and reflects blood clot formation and its subsequent fibrinolysis. https://t.co/lNoJHQfDSN

— Christine Ross DVM (@AnimalHRV) April 24, 2020

https://twitter.com/ElsayedIngi/status/1254175051299110913