Obesity and Acute Pulmonary Embolism: Clinical Implications and Knowledge Gaps

Obesity presents unique clinical challenges in the management of acute pulmonary embolism (PE), requiring a tailored approach to both diagnosis and treatment. However, current international guidelines offer limited guidance on specific strategies for managing PE in patients with obesity, often leaving clinicians with uncertainty. The coexistence of obesity and PE complicates diagnostic accuracy due to technical limitations and significantly influences both pharmacologic and interventional treatment decisions. Adding to this complexity is the "obesity paradox," whereby overweight and obese patients may exhibit better survival outcomes than those of normal weight, a phenomenon that complicates the understanding of PE pathophysiology and may contribute to the under-recognition of key risk factors for acute PE. This comprehensive overview offers a comprehensive analysis of the intricate relationship between obesity and PE, emphasizing pathophysiological mechanisms, clinical implications, diagnostic challenges, and evidence-based management approaches.