How I evaluate and treat patients with SCD with VTE
| Diagnosis | Little utility to D-dimer |
| Compression ultrasonography (±Doppler) for deep venous thrombosis | |
| Computed tomography angiography with nonionic low-osmolality contrast media | |
| I do not routinely give red cell transfusion before contrast | |
| As with the general population, V/Q scans now rarely performed | |
| Therapy | Treatment as per American College of Chest Physicians 2016 guidelines with full-dose anticoagulation |
| Caution in patients with history of ischemic stroke at risk for moyamoya syndrome | |
| 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 | |
| No convincing evidence to support primary prophylaxis for those with a catheter and no history of thrombosis | |
| I do not recommend primary thromboprophylaxis for pregnant patients with sickle cell who have never had a VTE | |
| Low molecular weight heparin during pregnancy and 6 wk postpartum for a patient with any prior VTE (if catheter-related, only if the catheter in still in place) |
| Diagnosis | Little utility to D-dimer |
| Compression ultrasonography (±Doppler) for deep venous thrombosis | |
| Computed tomography angiography with nonionic low-osmolality contrast media | |
| I do not routinely give red cell transfusion before contrast | |
| As with the general population, V/Q scans now rarely performed | |
| Therapy | Treatment as per American College of Chest Physicians 2016 guidelines with full-dose anticoagulation |
| Caution in patients with history of ischemic stroke at risk for moyamoya syndrome | |
| 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 | |
| No convincing evidence to support primary prophylaxis for those with a catheter and no history of thrombosis | |
| I do not recommend primary thromboprophylaxis for pregnant patients with sickle cell who have never had a VTE | |
| Low molecular weight heparin during pregnancy and 6 wk postpartum for a patient with any prior VTE (if catheter-related, only if the catheter in still in place) |