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Semin Thromb Hemost 2023; 49(08): 816-832
DOI: 10.1055/s-0042-1757634
Review Article

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment

Luis Ortega-Paz
1   Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
,
Azita H. Talasaz
2   Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
,
Parham Sadeghipour
3   Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
4   Clinical Trial Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
,
Tatjana S. Potpara
5   School of Medicine, University of Belgrade, Belgrade, Serbia
6   Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
,
Herbert D. Aronow
7   Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
8   Department of Cardiology, Henry Ford Health, Detroit, Michigan
,
Luis Jara-Palomares
9   Respiratory Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
10   Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain
,
Michelle Sholzberg
11   Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
12   Department of Medicine, University of Toronto, Toronto, Ontario, Canada
13   Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
,
Dominick J. Angiolillo
1   Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
,
Gregory Y.H. Lip
14   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
15   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Behnood Bikdeli
16   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
17   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
18   Yale/YNHH Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
19   Cardiovascular Research Foundation (CRF), New York, New York
› Author Affiliations Funding No specific funding was sought for this manuscript. L.O-P. was supported by a grant from the Spanish Society of Cardiology (SEC/MHE-MOV-INT 20/001). B.B. is supported by the Scott Schoen and Nancy Adams IGNITE Award from the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital and a Career Development Award from the American Heart Association and VIVA Physicians (#938814) and the Heart and Vascular Center Award from Brigham and Women's Hospital.
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Abstract

COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and a hypercoagulable state. The end result of this thromboinflammatory state is an excess in thrombotic events, in particular venous thromboembolism. Pulmonary embolism (PE) has been of special interest in patients with COVID-19 given its association with respiratory deterioration, increased risk of intensive care unit admission, and prolonged hospital stay. The pathophysiology and clinical characteristics of COVID-19-associated PE may differ from the conventional non–COVID-19-associated PE. In addition to embolic events from deep vein thrombi, in situ pulmonary thrombosis, particularly in smaller vascular beds, may be relevant in patients with COVID-19. Appropriate prevention of thrombotic events in COVID-19 has therefore become of critical interest. Several changes in viral biology, vaccination, and treatment management during the pandemic may have resulted in changes in incidence trends. This review provides an overview of the pathophysiology, epidemiology, clinical characteristics, and risk factors of COVID-19-associated PE. Furthermore, we briefly summarize the results from randomized controlled trials of preventive antithrombotic therapies in COVID-19, focusing on their findings related to PE. We discuss the acute treatment of COVID-19-associated PE, which is substantially similar to the management of conventional non-COVID-19 PE. Ultimately, we comment on the current knowledge gaps in the evidence and the future directions in the treatment and follow-up of COVID-19-associated PE, including long-term management, and its possible association with long-COVID.

Keywords

SARS-CoV-2 - coronavirus disease 2019 - long COVID - pulmonary embolism - venous thromboembolism - anticoagulant therapy


Publication History

Article published online:
12 October 2022

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