Ann Vasc Surg. 2020 Sep 3:S0890-5096(20)30768-8. doi: 10.1016/j.avsg.2020.08.088. Online ahead of print.
There is mounting evidence that COVID-19 patients may possess a hypercoagulable profile that increases their risk for thromboembolic complications, including pulmonary embolism. Pulmonary embolism has been associated with an increase in morbidity, mortality, prolonged ventilation, and extended ICU admissions. Intervention is warranted in some patients who develop acute massive and sub-massive PEs. However, the development of PE in COVID-19 patients is often complicated by such factors as delay of diagnosis, confounding medical conditions, and strict isolation precautions. In addition, depleted cardiopulmonary reserve and prone positioning can make management of pulmonary embolism in these patients especially challenging for the physician. In this paper, we review current understanding of pulmonary embolism in COVD-19 patients, summarize consensus data regarding the treatment of pulmonary embolism, and propose an algorithm to guide the management of COVID-19 patients with pulmonary embolism.