Diagnostic Management of Acute Pulmonary Embolism in COVID-19 and Other Special Patient Populations

Diagnostics (Basel). 2022 May 30;12(6):1350. doi: 10.3390/diagnostics12061350.


Venous thromboembolism (VTE), in particular acute pulmonary embolism (PE), has been shown to be a frequent and potentially fatal complication of coronavirus disease 2019 (COVID-19). In response to the observed thrombotic complications, a large number of studies has been devoted to the understanding and management of COVID-19-associated coagulopathy. Notably, only a limited number of mostly retrospective studies has focused on the optimal diagnostic strategy for suspected PE in COVID-19 patients. As in other special populations, the accuracy of diagnostic algorithms for PE-exclusion has been debated in this specific patient subgroup as the specificity of D-dimer assays and clinical decision rules (CDRs) may be lower than normal. From this viewpoint, we discuss the current state-of-the-art diagnostic algorithms for acute PE with a focus on patients with COVID-19 in the perspective of other special patient populations. Furthermore, we summarize current knowledge regarding the natural history of PE resolution with anticoagulant treatment in patients with COVID-19.

Keywords: COVID-19; D-dimer; computed tomography; diagnosis; pulmonary embolism; venous thromboembolism.

Publication types

  • Review

Grants and funding

F.A.K. reports research grants from Bayer, Bristol-Myers Squibb, The Netherlands Organisation for Health Research and Development, Actelion, the Dutch Heart foundation and the Dutch Thrombosis association, outside the submitted work. M.V.H. reports research grants from Dutch Organisation for Health Research and Development, Dutch Heart Foundation, Bayer Health Care, Pfizer-BMS and Leo Pharma, outside the submitted work.