Ortega-Paz Luis, Talasaz Azita H, Sadeghipour Parham, Potpara Tatjana S, Aronow Herbert D, Jara-Palomares Luis, Sholzberg Michelle, Angiolillo Dominick J, Lip Gregory Y H, Bikdeli Behnood
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida.
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Semin Thromb Hemost. 2023 Nov;49(8):816-832. doi: 10.1055/s-0042-1757634. Epub 2022 Oct 12.
COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and a hypercoagulable state. The end result of this thromboinflammatory state is an excess in thrombotic events, in particular venous thromboembolism. Pulmonary embolism (PE) has been of special interest in patients with COVID-19 given its association with respiratory deterioration, increased risk of intensive care unit admission, and prolonged hospital stay. The pathophysiology and clinical characteristics of COVID-19-associated PE may differ from the conventional non-COVID-19-associated PE. In addition to embolic events from deep vein thrombi, in situ pulmonary thrombosis, particularly in smaller vascular beds, may be relevant in patients with COVID-19. Appropriate prevention of thrombotic events in COVID-19 has therefore become of critical interest. Several changes in viral biology, vaccination, and treatment management during the pandemic may have resulted in changes in incidence trends. This review provides an overview of the pathophysiology, epidemiology, clinical characteristics, and risk factors of COVID-19-associated PE. Furthermore, we briefly summarize the results from randomized controlled trials of preventive antithrombotic therapies in COVID-19, focusing on their findings related to PE. We discuss the acute treatment of COVID-19-associated PE, which is substantially similar to the management of conventional non-COVID-19 PE. Ultimately, we comment on the current knowledge gaps in the evidence and the future directions in the treatment and follow-up of COVID-19-associated PE, including long-term management, and its possible association with long-COVID.
在强烈的炎症反应和高凝状态背景下，新型冠状病毒肺炎（COVID-19）与内皮激活有关。这种血栓炎症状态的最终结果是血栓形成事件增加，尤其是静脉血栓栓塞。鉴于肺栓塞（PE）与呼吸功能恶化、入住重症监护病房风险增加以及住院时间延长有关，因此在COVID-19患者中受到特别关注。COVID-19相关PE的病理生理学和临床特征可能与传统的非COVID-19相关PE有所不同。除了来自深静脉血栓的栓塞事件外，原位肺血栓形成，尤其是在较小血管床中的血栓形成，在COVID-19患者中可能也很重要。因此，对COVID-19患者进行适当的血栓形成事件预防已成为至关重要的问题。大流行期间病毒生物学、疫苗接种和治疗管理的一些变化可能导致了发病率趋势的改变。本综述概述了COVID-19相关PE的病理生理学、流行病学、临床特征和危险因素。此外，我们简要总结了COVID-19预防性抗血栓治疗随机对照试验的结果，重点关注其与PE相关的发现。我们讨论了COVID-19相关PE的急性治疗，这与传统的非COVID-19 PE的管理基本相似。最后，我们对现有证据中的知识空白以及COVID-19相关PE治疗和随访的未来方向进行了评论，包括长期管理及其与“长新冠”的可能关联。
