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Salvatore Massimo Petrina: Top 5 Game-Changers in the AHA and ACC PE Guidelines
Photo: reumamedica.it
Feb 23, 2026, 16:33

Salvatore Massimo Petrina: Top 5 Game-Changers in the AHA and ACC PE Guidelines

Salvatore Massimo Petrina, Hospital Physician in Cardiology at the Provincial Health Authority of Ragusa, shared a post on LinkedIn:

“The newly released 2026 AHA/ACC Guidelines for the Evaluation and Management of Acute Pulmonary Embolism represent a monumental shift in emergency and critical care medicine. We are moving from empirical estimation to rigorous precision.

Based on an analysis of the new text, here are the Top 5 Game-Changers every clinician needs to know:

1. The New Alphabet of Risk (Categories A-E) 

We are officially abandoning the vague ‘Massive/Submassive’ terminology. The new guidelines introduce specific Clinical Categories A through E:

  • Category A: Asymptomatic/Subclinical (incidental findings).
  • Category B: Symptomatic but low risk (often suitable for early discharge).
  • Category C: High risk (RV dysfunction/biomarkers) but hemodynamically stable.
  • Category D: Incipient failure (‘Normotensive shock’).
  • Category E: Circulatory collapse (Refractory shock/Arrest).
  • Note: The ‘R’ modifier is added for severe respiratory distress, shifting priority to oxygenation strategies,,.

2. The Rise of the PERT

The guidelines now formally recommend Pulmonary Embolism Response Teams (PERT) for high-risk patients (Categories C-E). This multidisciplinary approach is no longer a luxury; it is the standard to reduce decision time for advanced therapies like catheter-directed thrombolysis or ECMO,.

3. Smarter Diagnostics: The YEARS Algorithm

To reduce unnecessary imaging (and radiation), the guidelines endorse the YEARS algorithm.

  •  The 3 Simple Criteria: 1) Clinical signs of DVT, 2) Hemoptysis, 3) PE is the most likely diagnosis.
  • The New Threshold: If a patient has 0 Criteria, the D-dimer safety threshold jumps to less than 1,000 ng/mL (double the standard cutoff),.
  • Pregnancy Impact: Applying the Pregnancy-Adapted YEARS criteria allows clinicians to avoid CT imaging (and maternal breast radiation) in up to 65% of patients during the first trimester,.

4. Critical Pitfalls to Avoid 

  • IVC Filters: Routine placement in anticoagulated patients is Class 3 (Harm/No Benefit). They do not improve survival and increase long-term DVT risk.
  • Sedation: Be extremely cautious with sedation/intubation in patients with RV dysfunction (Categories C-E). It can precipitate immediate hemodynamic collapse by blunting adrenergic tone.
  • Systemic Thrombolysis: Should not be used for low-risk (Category A-B) patients due to bleeding risks outweighing benefits,.

5. The “So What”: The Long Game 

Acute management is just the beginning. The guidelines mandate follow-up for at least one year to screen for Chronic Thromboembolic Pulmonary Disease (CTEPD).

The initial CT scan is now seen as a prognostic tool to predict future fibrosis and chronic limitations,.

This document isn’t just an update on dosages; it is a structural reorganization of how we visualize PE.”

Proceed to the video attached to the post.

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2026 AHA/ACC Guidelines Acute Pulmonary Embolism bleeding disorders Evaluation and Management of Acute Pulmonary Embolism Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Salvatore Massimo Petrina thrombosis
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