COVID-19 has a wide spectrum of clinical presentations, from asymptomatic cases to severe respiratory distress, multi-organ dysfunction, and death. Pulmonary embolism (PE) is the most feared and severe complication of venous thromboembolism (VTE). We present a case of a 25-year-old nonsmoker pregnant woman (gravida 2, no history of abortion/miscarriage), who underwent an elective cesarean section at 39 weeks of gestation after uneventful pregnancy. She exhibit clinical presentation of pulmonary embolism (PE) overlapping with severe COVID-19 pneumonia. The diagnosis was made based upon severe oxygen desaturation, McConnel sign finding on POCUS and elevated D-dimer level (34.19 µg/mL). Alteplase and low-molecular-weight heparin were used, which resulted in rapid clinical improvement. We should be warned about high or extremely elevated D-dimer levels and severe oxygen desaturation, as markers of severe COVID-19 pneumonia in patients with high clinical suspicion of PE. Thrombolysis could be an effective and safe therapy for PE in ARDS secondary to COVID-19. Furthermore, we underline that POCUS, despite its inherent limitations, could be a flexible diagnostic and management tool in refractory ARDS due to COVID-19. Key words: COVID-19; SARS-CoV-2; Pulmonary Embolism; Thrombolysis; Postpartum; POCUS Abbreviations: ARDS - Acute respiratory distress syndrome; PE - Pulmonary embolism; VTE - Venous thromboembolism; BPM – Beats per minute Citation: Rotua SH, Arilaksono DG, Hutajulu SV. Systemic thrombolysis and anticoagulation in postpartum patient with acute respiratory distress syndrome, COVID-19 and acute pulmonary embolism: a case report. Anaesth. pain intensive care 2022;26(1):115-118. DOI: 10.35975/apic.v26i1.1777 Received: September 13, 2021, Reviewed: November 06, 2021, Accepted: November 10, 2021