Table 2.

Important Considerations During Follow-up Clinic

Issues to Address
Hand off •Assure appropriate hand off from inpatient provider/team to outpatient provider to minimize loss of information during this critical transition of care
Location of visit •If possible, perform virtually during the COVID-19 pandemic
Hospital course •Review hospital events with patient; often patients do not recall any of the specifics, especially if disease course was complicated
Etiology of PE •Explain coagulopathic state associated with COVID-19 •Ensure up to date age-specific cancer screening •For women, depending on age: mammogram, pap smear, and colonoscopy •For men, depending on age: colonoscopy and discuss utility of checking PSA with PCP •Consider thrombophilia testing only in patients who had VTE in unusual sites, recurrent VTE, or strong family history of VTE AND results will change management for patient or impact family member
Anticoagulation •Through shared decision-making with the patient, decide on type, dose, and duration •Discuss side effects of medication •Address costs and insurance coverage •Emphasize importance of adherence and encourage compliance •Point out any special considerations with the medications (ie, need to take with food)
Adjunctive therapies •If IVC filter in place, schedule removal when appropriate
Abnormal findings •Repeat ECHO if previous ECHO had evidence of right heart strain or other concerning findings •Ensure repeat testing and workup if any persistent abnormal laboratory values such as anemia
Complications: evaluation and management •Be aware of any signs or symptoms suggestive of PTSD or postthrombotic syndrome and provide treatment •Ask about persistent dyspnea on exertion and, if present, investigate for post-PE syndrome, pulmonary hypertension, chronic PEs, or CTEPH
COVID-19/PE registry •Consider joining to help provide expedient public reporting of aggregate data on the clinical characteristics and outcomes of patients with COVID-19 and PE

CTEPH = chronic thromboembolic pulmonary hypertension; ECHO = echocardiogram; IVC = inferior vena cava; PCP = primary care physician; PSA = prostate-specific antigen; PTSD = posttraumatic stress disorder. See Table 1 legend for expansion of other abbreviations.