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Francisco Chacón-Lozsán: Insights on Intermediate High Risk Pulmonary Embolism from ACVC 2026
Francisco Chacón-Lozsán/LinkedIn
Mar 21, 2026, 16:47

Francisco Chacón-Lozsán: Insights on Intermediate High Risk Pulmonary Embolism from ACVC 2026

Francisco Chacón-Lozsán, Fellow at World Extreme Medicine, Member of European Society of Intensive Care Medicine (ESICM) and American College of Cardiology, shared on LinkedIn:

”ACVC 2026 | Intermediate High Risk Pulmonary Embolism: Are we underestimating the danger.

At ACVC26, an important question was raised:

  • Are intermediate high risk PE patients more unstable than we think
  • The hidden risk in intermediate high risk PE
  • Intermediate high risk PE is not benign.

Key determinants of worse outcome include:

  • Right ventricular dysfunction RV greater than LV
  • Elevated biomarkers
  • Increased lactate levels
  • Acute kidney injury
  • Mean arterial pressure trends

These parameters identify patients closer to hemodynamic collapse than previously assumed

Lessons from PEITHO trial

In intermediate risk PE:

  • Reduction in hemodynamic decompensation with thrombolysis
  • No significant mortality reduction
  • Increased major bleeding and intracranial hemorrhage

Clinical benefit is offset by safety concerns

Normotensive shock concept

A critical concept highlighted:

Shock without hypotension
Defined by:

  • Elevated lactate
  • Reduced urine output
  • Worsening renal function
  • Impaired tissue perfusion

These patients may appear stable but carry high mortality risk

Risk stratification beyond classical models

Additional tools improve identification of high risk patients:

  • Critical Care Cardiology Trials Network classification
  • Composite Pulmonary Embolism Shock Score CPES

Higher CPES scores:

  • Associated with increased adverse outcomes
  • Predict progression toward shock.

Clinical implication

Intermediate high risk PE requires:

  • Early identification of deterioration signals
  • Integration of imaging, biomarkers, and perfusion markers
  • Recognition of normotensive shock.

A shift from static to dynamic risk assessment.

Take home message

Intermediate high risk PE is a dynamic and potentially unstable condition.

  • Not all normotensive patients are low risk
  • Early signs of hypoperfusion matter
  • Risk scores and physiology must guide decisions.

We may indeed be underestimating the danger.”

Francisco Chacón-Lozsán: Insights on Intermediate High Risk Pulmonary Embolism from ACVC 2026

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ACVC 2026 DVT Francisco Chacón-Lozsán Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine PE Pulmonary embolism thrombosis VTE
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