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.