Table 3.

Indications for the management of VTE in patients with COVID-19

In patients with a worsening clinical status, especially in those without anticoagulant treatment, a diagnosis of VTE must always be suspected

In patients with suspected VTE, the diagnostic and therapeutic workup must integrate clinical data, laboratory findings, and imaging test results

Measurement of D-dimer for diagnosing VTE must be performed only if a clinical suspect exists

Vascular/cardiac ultrasound imaging for diagnosing VTE should precede radiological imaging

Patients undergoing a CT scan for worsening respiratory status should receive angio-CT sequences to exclude PE

The use of LMWH for treating a VTE episode is preferred. UFH should be limited to patients with CrCl < 30 mL/min

An invasive “catheter”-based therapy for PE is indicated in selected cases with contraindication to anticoagulant drugs, recurrent events despite adequate anticoagulation, or when systemic fibrinolysis cannot be performed

For the risk stratification of patients with VTE, monitoring of the following parameters is useful: troponin, BNP, D-dimer, blood cell count, fibrinogen, prothrombin time, activated partial thromboplastin time, and degradation products of fibrin

After the initial approach, DOACs may represent an option for in-hospital treatment of a VTE episode in patients with clinical stability and decreasing inflammation

After a VTE episode, DOACs should represent the therapy of choice at discharge

BNP brain natriuretic peptide, COVID-19 coronavirus disease 2019, CrCl creatinine clearance, CT computed tomography, DOAC direct oral anticoagulant, LMWH low-molecular weight heparin, PE pulmonary embolism, UFH unfractionated heparin, VTE venous thromboembolism