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World J Radiol. Mar 28, 2021; 13(3): 64-74
Published online Mar 28, 2021. doi: 10.4329/wjr.v13.i3.64
COVID-19 and venous thromboembolism: Known and unknown for imaging decisions
Love Patel, Darshan Gandhi, Emily Westergard, Michael Ornes, Matthew Lillyblad, Nedaa Skeik
Love Patel, Michael Ornes, Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
Darshan Gandhi, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
Emily Westergard, Department of Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, MN 55408, United States
Matthew Lillyblad, Department of Pharmacy, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
Nedaa Skeik, Minneapolis Heart Institute, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States
Author contributions: Patel L conceived the idea of this article and contributed to writing the manuscript substantially; Gandhi D contributed to the discussion of the manuscript substantially with the contribution of imaging; Westergard E contributed to the manuscript formatting and revision; Ornes M contributed to reference numbering and designing the algorithm; Lillyblad M contributed to the design and revision of the manuscript; Skeik N contributed to the discussion of the manuscript substantially and editing.
Conflict-of-interest statement: The authors declare that they have no competing or conflicts of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Darshan Gandhi, MD, Academic Fellow, Doctor, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611, United States. darshan.gandhi@northwestern.edu
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 1, 2021
Revised: March 2, 2021
Accepted: March 22, 2021
Article in press: March 22, 2021
Published online: March 28, 2021
Abstract

As we continue to fight against the current coronavirus disease-2019 (COVID-19) pandemic, healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination. Since early in the pandemic, studies indicated a heightened risk of venous thromboembolism (VTE) in COVID-19 infected patients. There have been differing expert opinions about how to assess pretest probability of VTE in this patient population. This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE. Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough. Some have argued for more routine screening at different points of care. Others have even suggested empiric therapeutic anti-coagulation in moderate to severely ill COVID-19 patients. In the following article, we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients. We also discuss research gaps and share pathways currently being used within our institution.

Keywords: COVID-19, Venous thromboembolism, Computed tomography scan, Anticoagulation, Point of care ultrasound

Core Tip: As we continue to fight against the current coronavirus disease-2019 (COVID-19) pandemic, healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination. Since early in the pandemic, studies indicated a heightened risk of venous thromboembolism (VTE) in COVID-19 infected patients. There have been differing expert opinions about how to assess pretest probability of VTE in this patient population. This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE. Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough. Some have argued for more routine screening at different points of care. Others have even suggested empiric therapeutic anticoagulation in moderate to severely ill COVID-19 patients. In the following paper we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients. We also discuss research gaps and share pathways currently being used within our institution.