Venous Thromboemboly in Covid-19

DR. dr. Idar Mappangara, Sp.PD, Sp.JP (K)

Cardiolovascular Department
Medical Faculty of Hasanuddin University
Makassar
 • The Coronavirus disease 2019 (COVID-19) has become a global pandemic. Since
December 2019, the total number worldwide of confirmed cases is 2,356,414 with
mortality rate 6.8% involving 213 countries all over the world (WHO data April
21,2020).
• The clinical spectrum of Covid 19 ranges from mild to critically ill cases
• The previous studies revealed that old age, increased SOFA scores, Greater D-
Dimer level more than 1000 ng/mL, and those have preexisting comorbidities are
more likely to have prognosis.
• Patient with COVID-19 who fell into severe or critical condition is exposed to
venous thromboembolism potential risk factors such as infection, immobilization,
respiratory failure, hypoxia, mechanical ventilation, and use of central venous
catheter (CVC).

Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of
Medical Sciences, 2020.
 Venous Thromboembolism
• Venous Thromboembolism (VTE), clinically presenting as DVT
and PE, is globally the third most frequent acute
cardiovascular syndrome behind myocardial infarction and
stroke.
• In a US Registry of patients with coronavirus disease 2019
(COVID-19), thrombotic complication occurred in 2.6% of 299
non critically ill hospitalized patient and in 35.3% of 170
hospitalized critically ill patients.
Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of
Medical Sciences, 2020.
Gregory P, Morrow A. D. Diagnosis, Management and Phatophysiology of Arterial and Venous Thrombosis in Covid-19 : Journal of American Medical Association,
2020.
 Venous Thromboembolism (VTE)

Deep Vein Thrombosis (DVT) Pulmonary Embolism (PE)

 Risk of VTE in Hospitalized Patient with Covid-19

Fontana P, Casini A, Robert-Ebadi H, et al. Venous Thromboembolism in Covid-19: Systematic Review, of reported risk and current guidelines. Swiss Medical weekly,
2020.
 Prevalence of VTE, DVT and PE in ICU and ward hospitalized patients with COVID-19

Nopp S, Moik F, Jilma B, Pabinger I, Ay Cilma. Risk of Venous Thromboembolism in patients with COVID-19: a Systematyc Review and Meta-Analysis. 2020
 Trias Virchow’s

Kumar V, Abbas A, editors : Hemodynamic dysorders, thromboembolic disease and shock, in: Robins and Conrans pathologic basis of disease, Elsevier; 2015.p.113-35.
 PATHOMECHANISM

Price L.G, McCabe C, Garfield B, et al. Thrombosis

and COVID 19 Pneumonia: The Clot Thickens!. Eur
Respir J. 2020.
 Risk Assesment of VTE in Covid 19

IMPROVE-VTE
High Risk patient for VTE is total Score 4 or 2-3 with Increased
D-Dimer level twice the upper limit normal range

Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of Medical
Sciences, 2020.
 Algorithm Coagulopathy for prevention VTE in patients with COVID-19

Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of Medical Sciences,
2020.
Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism
and Current Recommendation of Thromboembolism in COVID-19:
Macedonian Journal of Medical Sciences, 2020.
 Current Gudeline recommendations for VTE prevention in Hospitalized patients
with COVID-19

Gregory P, Morrow A. D. Diagnosis, Management and Phatophysiology of Arterial and Venous Thrombosis in Covid-19 : Journal of American Medical Association, 2020.
Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of Medical Sciences,
2020.
Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in COVID-19: Macedonian Journal of
Medical Sciences, 2020.
 Risk Score for DVT
The Wells scoring system for evaluating the probability of DVT

Interpretation :
• High Probability of DVT Score > 2 pts
• Moderate Probability of DVT Score 1-2 pts
• Low Probability of DVT Score < 1 pts

Osman A.A, Ju. W, Sun D, Qi B. Deep Vein Thrombosis: a literature review; International J Clin Exp Med. 2018.
 RISK SCORE FOR PULMONARY
EMBOLISM

Guo Dan-Jie, Zhao C, Zou Ya-Dan, Huang Xu-Huang, Hu Jung-Min, Guo Lin. Values of the Wells and revised Geneva Scores Combined with D-Dimer in Diagnosing
Elderly Pulmonary Embolism patients; Chinese Medical journal. 2015.
 Diagnosis of Acute Pulmonary Embolism

Stravos V. K, Mayer G, Becattini C, et. Al. 2019 ESC Guidelines fot the Diagnosis and Management of Acute Pulmonary Embolism developed in Collaboration with the
European Respiratory Society (ERS). 2019
 Management Strategy of Acute Pulmonary Embolism

Stravos V. K, Mayer G, Becattini C, et. Al. 2019 ESC Guidelines fot the Diagnosis and Management of Acute Pulmonary Embolism developed in Collaboration with the
European Respiratory Society (ERS). 2019
THANK YOU
 References
1. Aulia Rachmi D, Prasetya Budi M E, Nugroho J. Possible Mechanism and Current Recommendation of Thromboembolism in
COVID-19: Macedonian Journal of Medical Sciences, 2020.
2. Gregory P, Morrow A. D. Diagnosis, Management and Phatophysiology of Arterial and Venous Thrombosis in Covid-19 :
Journal of American Medical Association, 2020.
3. Fontana P, Casini A, Robert-Ebadi H, et al. Venous Thromboembolism in Covid-19: Systematic Review, of reported risk and
current guidelins. Swiss Medical weekly, 2020.
4. Nopp S, Moik F, Jilma B, Pabinger I, Ay Cilma. Risk of Venous Thromboembolism in patients with COVID-19: a Systematyc
Review and Meta-Analysis. 2020
5. Kumar V, Abbas A, editors : Hemodynamic dysorders, thromboembolic disease and shock, in: Robins and Conrans pathologic
basis of disease, Elsevier; 2015.p.113-35.
6. Price L.G, McCabe C, Garfield B, et al. Thrombosis and COVID 19 Pneumonia: The Clot Thickens!. Eur Respir J. 2020.
7. Osman A.A, Ju. W, Sun D, Qi B. Deep Vein Thrombosis: a literature review; International J Clin Exp Med. 2018.
8. Guo Dan-Jie, Zhao C, Zou Ya-Dan, Huang Xu-Huang, Hu Jung-Min, Guo Lin. Values of the Wells and revised Geneva Scores
Combined with D-Dimer in Diagnosing Elderly Pulmonary Embolism patients; Chinese Medical journal. 2015.
9. Stravos V. K, Mayer G, Becattini C, et. Al. 2019 ESC Guidelines fot the Diagnosis and Management of Acute Pulmonary
Embolism developed in Collaboration with the European Respiratory Society (ERS). 2019