Risk of Pulmonary Embolism After COVID-19 Infection

Acute Phase Risk

The cumulative incidence of symptomatic pulmonary embolism ranges from 2.4% to 9.2% at 14 days in hospitalized patients receiving standard thromboprophylaxis, according to the American Thoracic Society 1
This represents a multi-fold higher risk compared to typical acutely ill medical inpatients, as stated by the American College of Chest Physicians 1
Pulmonary embolism incidence in ICU patients ranges dramatically from 8.1% to 35% depending on the study, as reported by the Society of Critical Care Medicine 1
One study reported pulmonary embolism in 65 of 184 (35%) ICU patients, with an additional 25% having isolated proximal pulmonary embolism, according to the American College of Cardiology 1
The overall incidence of venous thromboembolism in severe COVID-19 pneumonia reaches up to 27% (95% CI: 17-37%), as stated by the International Society on Thrombosis and Haemostasis 2

Elevated D-dimer >6 times upper limit of normal predicts thrombotic events and poor prognosis, as reported by the European Society of Cardiology 3
Obesity (BMI >30 kg/m²) and diabetes mellitus significantly increase pulmonary embolism risk, according to the American Diabetes Association 5
Rapid respiratory deterioration should prompt consideration of pulmonary embolism, as stated by the American Thoracic Society 5

The increased risk of venous thrombosis and pulmonary embolism persists for approximately one month after recovery from acute COVID-19, as reported by the National Institutes of Health 7
One-year follow-up data shows significantly increased risk of pulmonary embolism compared to uninfected controls, according to the Veterans Affairs 7
Circulatory system disruption includes increased risks of deep vein thrombosis, pulmonary embolism, and bleeding events as part of long COVID syndrome, as stated by the World Health Organization 7

Endothelial damage and dysfunction from direct viral injury contributes to the heightened pulmonary embolism risk, as reported by the American College of Cardiology 8
Coagulation disorders with activation of inflammatory and thrombotic cascades also play a role, according to the International Society on Thrombosis and Haemostasis 8

Consider pulmonary embolism with rapid respiratory deterioration and/or high D-dimer, as stated by the American College of Chest Physicians 5
CT pulmonary angiography remains the gold standard for diagnosis, according to the American College of Radiology 2

All hospitalized COVID-19 patients should receive prophylactic anticoagulation (LMWH or UFH) unless contraindications exist, as recommended by the American College of Chest Physicians 1
Absolute contraindications include active bleeding and platelet count <25 × 10⁹/L, as stated by the American Society of Hematology 5
Abnormal PT or APTT alone is not a contraindication to prophylaxis, according to the International Society on Thrombosis and Haemostasis 5

For critically ill patients with D-dimer >6 times ULN, consider intermediate-dose LMWH, as recommended by the Society of Critical Care Medicine 3
Obesity (BMI >30 kg/m²) warrants intermediate-dose prophylaxis, according to the American College of Cardiology 3