Radiologists Warned to Watch Out for Possible Blood Clot Dangers in COVID-19 Patients

The National Institute for Public Health and the Environment (Bilthoven, 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 summarizes evidence for thromboembolic disease and potential diagnostic and preventive actions that can be taken.

Recent observations suggest that respiratory failure in COVID-19 is not driven by the development of the acute respiratory distress syndrome alone, but that microvascular thrombotic processes could play a role. This could have important consequences for the diagnostic and therapeutic management of COVID-19 patients. There is a strong association between D-dimer levels, disease progression and chest CT features suggesting venous thrombosis. Additionally, various studies in patients with COVID-19 have demonstrated a very strong association between increased D-dimer levels and severe disease/poor prognosis.

The report stresses on the need to pay careful attention to the initial diagnosis and treatment of the prothrombotic and thrombotic state that can occur in a substantial percentage of COVID-19 patients. 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.

“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 Edwin J.R. van Beek, M.D., Ph.D., director at Edinburgh Imaging, Queens Medical Research Institute, at the University of Edinburgh, U.K. “This highly thrombotic syndrome leads to macro-thrombosis and embolism. Therefore, strict thrombosis prophylaxis, close laboratory and appropriate imaging monitoring with early anti-coagulant therapy in case of suspected venous thromboembolism are indicated.”

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National Institute for Public Health and the Environment