What to Know About Pulmonary Embolism and COVID-19

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Researchers have found that having a COVID-19 infection puts people at an increased risk of developing a pulmonary embolism (PE). This serious and potentially life-threatening condition occurs when blood clots travel from another part of the bloodstream (usually the leg) to the lungs. There, they can cause permanent damage to the lungs, as well as reduce oxygen in the blood and other organs.

While research on the connection between COVID-19 and pulmonary embolisms is ongoing, this article discusses what is known about the link between the two conditions, risks, treatments, and considerations.

Covid patient in the ICU with a higher risk of pulmonary embolism.

Jackyenjoyphotography / Getty Images

Pulmonary Embolism and COVID-19 Risk

Researchers have found an increased PE risk in certain populations of people with COVID-19, making some people twice as likely to develop blood clots in their lungs (pulmonary embolism). For instance, sbout 10% to 40% of COVID-19 patients in hospital intensive care units (ICUs) developed a PE.

Recent Research

In a study reviewing patients who previously had COVID-19, 1 in 5 people between the ages of 18 and 64 and 1 in 4 people aged 65 and older had a post-COVID-19 condition. The risk of PE, one of the post-COVID-19 conditions reported, was twice as high for both age groups compared to those in the control group without COVID-19.

The increased risk for PE may be due to an irregular immune response caused by the COVID-19 infection. Typically, your body releases cytokines (proteins that help regulate the immune system) when you have an acute infection. However, when you have COVID-19, high amounts of cytokines can be released into the bloodstream too quickly, known as a cytokine storm.

This immune response may also increase the likelihood of developing venous thromboembolism (VTE), the blood clotting disorder that causes blood clots in the veins, including deep vein thrombosis (DVT) and PE.

Symptoms of Pulmonary Embolism

If you have a PE, you may not experience symptoms, but symptoms can include:

  • Shortness of breath
  • Feeling light-headed
  • Fainting
  • A rapid pulse or heartbeat
  • Chest pain
  • Coughing up blood

Because a blood clot in the leg (DVT) often causes PE, it's good to be aware of associated DVT symptoms. These can include redness, swelling, pain, and warmth in the leg.

Pulmonary Embolism Prevention With COVID-19

Because blood clots and related complications have been reported in 27% to 69% of critically ill patients with COVID-19, healthcare providers may recommend certain medications to reduce the risk of PE (drugs known as thromboprophylaxis). The type of medication and dosage depend on the severity of the COVID-19 illness.

Research has found that COVID-19 patients undergoing preventive thromboprophylaxis are at a lower risk for mortality than those not being treated. However, researchers also note that while there are guidelines for this type of preventive treatment, it's not clear how effective the medications are at reducing overall VTE, the disorder that causes clots in a PE.

Pulmonary Embolism Treatment With COVID-19

If a healthcare provider suspects you have a PE due to COVID-19, they will prescribe anticoagulant medications. These medications thin your blood and slow down the formation of blood clots in your body.

However, there may be interactions between some anticoagulant medications and medication used to treat severe COVID-19.

For instance, taking Xarelto (rivaroxaban), an anticoagulant medication to treat PE, while taking ritonavir—a main drug in the COVID-19 medication Paxlovid (nirmatrelvir and ritonavir)—can increase the amount of rivaroxaban in the body. In turn, this can result in a high risk of bleeding.

A healthcare provider can advise you on whether briefly pausing certain medications or finding alternative PE or COVID-19 treatments would reduce your risk of dangerous interactions.

How Pulmonary Embolism Is Diagnosed

PE is not always simple to diagnose. However, to determine whether you have a PE, a healthcare provider may:

Frequently Asked Questions

Are people who get the COVID-19 vaccine at a higher risk for blood clots?

Two COVID-19 vaccines, manufactured by AstraZeneca and Johnson & Johnson, have been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT). This condition causes blood clots in the veins or arteries.

Symptoms of VITT include severe headache, vision changes, stomach pain, nausea, vomiting, shortness of breath, back pain, and bruising easily. Many people diagnosed with VITT did not have other factors that increased their risk for blood clots.

The mRNA (messenger RNA) COVID-19 vaccines from Pfizer-BioNTech and Moderna have a much lower risk of VITT.

Are there factors that increase my risk for developing blood clots while having COVID-19?

Yes. You may be at a higher risk for blood clots associated with COVID-19 if you:

  • Had a severe COVID-19 infection that required hospitalization
  • Have a pre-existing health condition, such as diabetes, cancer, high blood pressure, or obesity
  • Have been immobile for an extended time
  • Have a history of blood clots or have a blood clotting disorder
  • Require a high amount of oxygen or have experienced severe breathing issues
  • Are older than 60
  • Were assigned male at birth

Does having PE and COVID-19 increase mortality risk?

Experiencing VTE while having COVID-19 can increase mortality risk. More specifically, researchers have found that people with VTE have an increased risk of being admitted to the hospital or dying after being diagnosed with COVID-19. Moreover, people who were already in the hospital for COVID-19 and who developed VTE had an increased risk of death.

How to Stay Safe

Avoiding health issues associated with COVID-19, such as PE, means reducing your risk of COVID-19 infection. Many of the same COVID-19 prevention strategies you may already be familiar with are recommended, including:

  • Getting vaccinated and staying up-to-date with boosters
  • Increasing ventilation in indoor spaces or spending more time outdoors
  • Getting tested for COVID-19 when needed to reduce the risk for others
  • Staying home if you suspect or have confirmed that you have COVID-19
  • Wearing masks or respirators (an N-95, for example)
  • Frequently washing your hands with soap and water for at least 20 seconds

Summary

A pulmonary embolism (PE) is a potentially life-threatening condition identified as a possible complication of COVID-19. The condition occurs when a blood clot (typically formed in the legs) travels through the bloodstream to the lungs. An irregular immune response due to COVID-19 may cause these clots.

People with severe COVID-19, particularly those treated in the ICU, are at a higher risk of PE. To reduce the risk of developing PE, people with severe COVID-19 are treated with preventive medication. If you experience PE when you have COVID-19, medications used to treat both conditions may interact and can increase the likelihood of bleeding. A healthcare provider can advise you on whether pausing certain medications or finding alternative treatments is necessary.

Using prevention strategies to avoid COVID-19 can help prevent PE associated with the infection. These include regular hand-washing, wearing masks, avoiding contact with people who currently have COVID-19, and getting vaccinated.

A Word From Verywell

Medical professionals and researchers continue to learn more about COVID-19 and other health conditions experienced as a result of the viral infection. Engaging in COVID-19 prevention strategies can lower your risk of infection and complications. Talk to your healthcare provider about any health issues or conditions that increase your risk for severe COVID-19.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Katie Wilkinson, MPH, MCHES
Katie Wilkinson is a public health professional with more than 10 years of experience supporting the health and well-being of people in the university setting. Her health literacy efforts have spanned many mediums in her professional career: from brochures and handouts to blogs, social media, and web content.