In the early months of 2020, clinician researchers working on the frontlines of the COVID-19 pandemic began reporting relevant data surrounding the incidence of various venous thromboembolism (VTE) manifestations in patients with COVID-19 infection. Some of the first studies out of China reported that the incidence of provoked VTE, including deep vein thrombosis and pulmonary embolism, appeared to be substantially higher in COVID-19 relative to similar respiratory diseases and acute medical illnesses. However, as larger and more robust studies were carried out around the world, it became clearer that VTE incidence in COVID-19 had likely been overestimated in the early analyses, with some studies showing similar rates of VTE among COVID-19 patients as others admitted with acute medical illnesses. Most studies, though, have established that rates of VTE, and specifically PE, are high in patients with severe COVID-19 infection requiring hospitalization or intensive care unit-level care. The pathophysiology of VTE in COVID-19 is complex, reflecting an interplay between coagulation and a local and systemic inflammatory response, as well as activation of endothelial cells, platelets, and leukocytes. In this section, we review in detail the incidence and pathophysiology of VTE in COVID-19, as understanding the complex science driving these processes will help to guide future diagnostic and treatment algorithms.