Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands

Matthijs Oudkerk, Harry R Büller, Dirkjan Kuijpers, Nick van Es, Sytse F Oudkerk, Theresa McLoud, Diederik Gommers, Jaap van Dissel, Hugo Ten Cate, Edwin J R van Beek, Matthijs Oudkerk, Harry R Büller, Dirkjan Kuijpers, Nick van Es, Sytse F Oudkerk, Theresa McLoud, Diederik Gommers, Jaap van Dissel, Hugo Ten Cate, Edwin J R van Beek

Abstract

A potential link between mortality, d-dimer values, and a prothrombotic syndrome has been reported in patients with coronavirus disease 2019 (COVID-19) infection. The National Institute for Public Health of the Netherlands asked a group of radiology and vascular medicine experts to provide guidance for the imaging work-up and treatment of these important complications. This report summarizes evidence for thromboembolic disease, potential diagnostic and preventive actions, and recommendations for prophylaxis and treatment of patients with COVID-19 infection.

© RSNA, 2020.

Figures

Figure 1:
Figure 1:
A schematic representation of the pathophysiological disease development of COVID-19, based on the results of the Wuhan population in the context of plasma D-dimer values, clinical and imaging characteristics (Clinical findings reconstructed from reference Zhou et al).
Figure 2:
Figure 2:
Chest CT images in 51-year-old male patient presenting with progressive symptoms of cough and fever, proven COVID-19. (A) Day 7 after onset of symptoms: CT demonstrates bilateral ground glass opacities (GGOs) and early vascular enlargement. (B) Day 10: Rapid progression of GGOs with vascular thickening and interstitial pulmonary edema. (Figure courtesy of Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands.)
Figure 3:
Figure 3:
This proof of concept demonstrates CT perfusion findings in phase 1 in a 43-year old female patient proven COVID-19 with multiple ground glass opacities, with plasma Ddimer

Figure 4:

Plasma D-dimer course in 43…

Figure 4:

Plasma D-dimer course in 43 consecutive patients with COVID-19, admitted to the intensive…

Figure 4:
Plasma D-dimer course in 43 consecutive patients with COVID-19, admitted to the intensive care unit. PE was diagnosed with CTPA in 35 patients. (Figure courtesy of Dr Diederik Gommers, Erasmus University Medical Centre, Rotterdam, the Netherlands).
Figure 4:
Figure 4:
Plasma D-dimer course in 43 consecutive patients with COVID-19, admitted to the intensive care unit. PE was diagnosed with CTPA in 35 patients. (Figure courtesy of Dr Diederik Gommers, Erasmus University Medical Centre, Rotterdam, the Netherlands).

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