SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

Abstract

Pulmonary embolism (PE) is a life-threatening complication arising from venous thromboembolism with a difficult diagnosis and treatment and is often associated with increased mortality and morbidity. PE had a significantly low incidence prior to the COVID-19 epidemic. This condition saw a sharp surge during the COVID-19 pandemic, indicating an evident viral influence on PE’s pathophysiology in COVID-19 patients. The hypercoagulable state induced by the viral load seems to be the major contributor, and the classical causative factors seem to play a lesser role. PE in COVID-19 infection has become a mammoth challenge since the diagnosis is quite challenging due to overlapping symptoms, lack of prior-known predisposing risk factors, limited resources, and viral transmittance risk. Numerous factors arising out of the viral load or treatment lead to an increased risk for PE in COVID-19 patients, besides the fact that certain unknown risk factors may also contribute to the incidence of PE in COVID-19 patients. The management of PE in COVID-19 infection mainly comprises thromboprophylaxis and anticoagulant therapy with mechanical ventilation, depending on the risk stratification of the patient, with a post-COVID-19 management that prevents recurrent PE and complications. This review aims to discuss various aspects of COVID-19-infection-associated PE and major differential aspects from non-COVID-19 PE.

Pulmonary Embolism in COVID-19 Patients: Facts and Figures

“…The risk factors of thromboembolism or PE in COVID-19 patients are not the same as traditional PE risk factors. Traditional risk factors including lower limb fractures, heart failure, hip or knee replacement surgeries, myocardial infarction, spinal trauma, post-partum period do not seem to increase the risk in COVID-19 patients, but sure there will be some relevance of these conditions on the occurrence of PE [7]. African American race and obesity are found to increase the risk of PE in COVID-19 patients.…”

“…African American race and obesity are found to increase the risk of PE in COVID-19 patients. There is no strong relationship between cardiovascular comorbidities and the risk of pulmonary embolism in COVID-19 patients [7]. Various studies reported that the clinical and biological parameters in COVID-19 patients driven by inflammation and coagulopathy increase the risk of PE.…”

“…Presence of severe inflammation with increase in D-dimers, C-reactive protein (CRP), high fractional inspiration of oxygen and development of ARDS (acute respiratory distress syndrome) were associated with increased risk of PE. Demographic factors increasing risk of PE included male gender, history of stroke, atrial fibrillation, chest pain and dyspnea [7]. COVID-19 patients requiring ECMO (Extracorporeal membrane oxygenation) and convalescent plasma therapy were also at a higher risk of PE [7].…”

“…Demographic factors increasing risk of PE included male gender, history of stroke, atrial fibrillation, chest pain and dyspnea [7]. COVID-19 patients requiring ECMO (Extracorporeal membrane oxygenation) and convalescent plasma therapy were also at a higher risk of PE [7]. Up to 39% of COVID-19 patients requiring invasive ventilation develop PE [7].…”

“…COVID-19 patients requiring ECMO (Extracorporeal membrane oxygenation) and convalescent plasma therapy were also at a higher risk of PE [7]. Up to 39% of COVID-19 patients requiring invasive ventilation develop PE [7].…”