Semin Thromb Hemost 2023; 49(01): 034-046
DOI: 10.1055/s-0041-1740152
Review Article

Pulmonary Embolism in Patients with COVID-19: Comparison between Different Care Settings

Giacomo Buso
1   Angiology Division, Heart and Vessels Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
Lucia Mazzolai
1   Angiology Division, Heart and Vessels Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
José Antonio Rueda-Camino
2   Department of Internal Medicine, Hospital Rey Juan Carlos, Madrid, Spain
Carmen Fernández-Capitán
3   Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
David Jiménez
4   Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
5   Medicine Department, Universidad de Alcala, Madrid, Spain
Behnood Bikdeli
6   Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
7   Yale/YNHH Center for Outcomes Research & Evaluation (CORE), New Haven, Connecticut
8   Cardiovascular Research Foundation (CRF), New York, New York
José Luis Lobo
9   Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
José Luis Fernández-Reyes
10   Department of Internal Medicine, Complejo Hospitalario de Jaén, Jaén, Spain
Maurizio Ciammaichella
11   Department of Emergency Internal Medicine, Ospedale St John, Rome, Italy
Manuel Monreal
12   Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol. Badalona, Barcelona, Spain
13   Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Spain
the RIETE Investigators › Author Affiliations


The clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) in the full spectrum of patient care settings need to be elucidated. The aim of this study was to compare the clinical characteristics, treatment, and 90-day outcomes in patients diagnosed with PE while recovering from COVID-19 in the outpatient setting versus those who were diagnosed with PE while being hospitalized with COVID-19. Data from the international Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry were used. The major study outcomes were all-cause death, major bleeding, and venous thromboembolism (VTE) recurrences during the first 90 days after PE. From March 2020 to March 2021, 737 patients with COVID-19 experienced acute PE. Of these, 340 (46%) were recovering from COVID-19 as outpatients (267 patients who had been treated at home for COVID-19 and 73 discharged after being hospitalized with COVID-19). Compared with inpatients with COVID-19, those recovering in the outpatient setting upon PE were less likely to be men (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.40–0.72) and less likely to have hypertension (OR: 0.55; 95% CI: 0.41–0.74) or diabetes (OR: 0.51; 95% CI: 0.33–0.76). At 90-day follow-up, eight patients (none recovering from COVID-19 as outpatient vs. 2.4% of inpatients with COVID-19) developed recurrent VTE, 34 (1.9 vs. 7.9%) had major bleeding, and 128 (10 vs. 24%) died. On multivariable analysis, inpatients with COVID-19 were at a higher risk of major bleeding (adjusted hazard ratio [HR]: 6.80; 95% CI: 1.52–30.4) or death (adjusted HR: 2.24; 95% CI: 1.40–3.58). In conclusion, using a large multinational registry of patients with COVID-19 who experienced PE, thromboembolic episodes occurring in those recovering from COVID-19 as outpatients were associated with less ominous outcomes than inpatients with COVID-19.


Coordinator of the RIETE Registry: Manuel Monreal.

RIETE Steering Committee Members: Paolo Prandoni, Benjamin Brenner and Dominique Farge-Bancel. RIETE National Coordinators: Raquel Barba (Spain), Pierpaolo DiMicco (Italy), Laurent Bertoletti (France), Sebastian Schellong (Germany), Inna Tzoran (Israel), Abilio Reis (Portugal), Marijan Bosevski (R. Macedonia), Henri Bounameaux (Switzerland), Radovan Malý (Czech Republic), Peter Verhamme (Belgium), Joseph A. Caprini (USA), Hanh My Bui (Vietnam).

RIETE Registry Coordinating Center: S & H Medical Science Service.

Publication History

Article published online:
13 December 2021

© 2021. Thieme. All rights reserved.

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