Summary of the approach to diagnosis and treatment of VTE in SCD
| . | VTE diagnosis and treatment approaches in SCD . |
|---|---|
| Diagnosis | • Compression ultrasonography (±Doppler) for deep venous thrombosis |
| • CTPA with nonionic low-osmolality contrast media | |
| o We do not routinely recommend red cell transfusion prior to contrast | |
| o Although less frequently performed V/Q scanning has clinical utility, especially when tested serially | |
| • D-dimer is routinely elevated in SCD precluding the high negative predictive value advantage this biomarker has in other settings | |
| Treatment | • Treatment as per ACCP 2016 guidelines with full-dose anticoagulation |
| o Potential for increased risk of bleeding in patients with MRA evidence for Moya Moya syndrome | |
| • Heparin, DOAC, or vitamin K antagonists are therapeutic options | |
| • In line with ACCP 2016 guidelines, our initial choice of anticoagulant is a DOAC if not contraindicated | |
| • Anticoagulate for at least 3 mo for VTE event | |
| • Consider extended anticoagulation in those with low bleeding risk even if the event was provoked by hospitalization for medical illness | |
| • Continue anticoagulation for catheter-associated upper-extremity thrombosis until catheter removal |
| . | VTE diagnosis and treatment approaches in SCD . |
|---|---|
| Diagnosis | • Compression ultrasonography (±Doppler) for deep venous thrombosis |
| • CTPA with nonionic low-osmolality contrast media | |
| o We do not routinely recommend red cell transfusion prior to contrast | |
| o Although less frequently performed V/Q scanning has clinical utility, especially when tested serially | |
| • D-dimer is routinely elevated in SCD precluding the high negative predictive value advantage this biomarker has in other settings | |
| Treatment | • Treatment as per ACCP 2016 guidelines with full-dose anticoagulation |
| o Potential for increased risk of bleeding in patients with MRA evidence for Moya Moya syndrome | |
| • Heparin, DOAC, or vitamin K antagonists are therapeutic options | |
| • In line with ACCP 2016 guidelines, our initial choice of anticoagulant is a DOAC if not contraindicated | |
| • Anticoagulate for at least 3 mo for VTE event | |
| • Consider extended anticoagulation in those with low bleeding risk even if the event was provoked by hospitalization for medical illness | |
| • Continue anticoagulation for catheter-associated upper-extremity thrombosis until catheter removal |
Adapted from Wun and Brunson.9
MRA, magnetic resonance angiography.