Table 2.

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

Adapted from Wun and Brunson.⁹

MRA, magnetic resonance angiography.