Unpacking the 2026 Guidelines for Acute Pulmonary Embolism: What Interventional Radiologists and Cardiologists Need to Know-Slides: AHA/ACA Acute PE Guidelines Overview, Dr. Giri

Slides: AHA/ACA Acute PE Guidelines Overview, Dr. Giri

Pdf Summary

The document summarizes the <strong>2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN guideline for acute pulmonary embolism (PE)</strong>, with a focus on <strong>advanced therapies</strong>.

Key points:
- <strong>VA-ECMO:</strong> In patients with suspected or confirmed acute PE on VA-ECMO, continuing <strong>parenteral systemic anticoagulation</strong> is recommended if there is no bleeding. For patients with <strong>refractory cardiogenic shock</strong> from PE, it is reasonable to start <strong>VA-ECMO</strong> to stabilize hemodynamics and oxygenation, though the benefit of adding other advanced therapies is uncertain.
- <strong>Systemic thrombolysis:</strong> For patients with acute PE and acceptable bleeding risk, systemic thrombolysis plus anticoagulation is:
  - <strong>Reasonable</strong> for <strong>high-risk or intermediate-high-risk PE (E1–E2)</strong> to reduce mortality and recurrent PE.
  - <strong>May be considered</strong> in some lower-risk categories to prevent deterioration.
  - <strong>Not recommended</strong> when bleeding risk is unacceptable, due to increased major bleeding and intracranial hemorrhage.
  - Lower-dose thrombolytics may be considered to reduce bleeding risk.
- <strong>Catheter-directed thrombolysis (CDL) and mechanical thrombectomy (MT):</strong>
  - Both may be reasonable in selected patients to prevent deterioration or mortality.
  - Their benefit over anticoagulation alone is often <strong>unclear</strong>.
  - MT may offer a bleeding-risk advantage compared with systemic thrombolysis.
  - Neither CDL nor MT is recommended routinely over anticoagulation alone for improving outcomes in lower-risk groups.
- <strong>Surgical embolectomy (SE):</strong>
  - Reasonable over anticoagulation alone in selected high-risk PE.
  - May be considered in some intermediate-risk cases.
  - Not recommended routinely over anticoagulation alone or over other advanced therapies in certain settings.

The slides also highlight ongoing and recent randomized trials, including <strong>PEERLESS II</strong> (FlowTriever vs anticoagulation in intermediate-risk PE), <strong>PERSEVERE</strong> (FlowTriever vs standard care in high-risk PE), and studies of <strong>ultrasound-assisted catheter-directed thrombolysis</strong>.

Keywords

acute pulmonary embolism

advanced therapies

VA-ECMO

systemic thrombolysis

catheter-directed thrombolysis

mechanical thrombectomy

surgical embolectomy

intermediate-high-risk PE

anticoagulation

PEERLESS II