Pulmonary embolism consensus

Pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality. Despite significant advances in diagnosis and treatment, important challenges persist in the early identification of patients at risk of clinical deterioration and in the integration of clinical, imaging, and biomarker data for more accurate risk stratification.

A multidisciplinary panel of experts reviewed the available scientific evidence, including international guidelines, randomized clinical trials, observational studies, and contemporary registries. Recommendations were developed through a structured consensus process, with particular emphasis on areas of uncertainty or ongoing evolution in clinical practice.

This document updates recommendations on the diagnosis, risk stratification, anticoagulation, reperfusion therapies, and follow-up of patients with acute PE. A key focus is the concept of dynamic risk assessment, recognizing that clinical status may change significantly during the first hours and days after diagnosis. As an innovative proposal, the Integrated Cardiorespiratory Involvement System (SIAC) is introduced as a complementary framework that integrates hemodynamic parameters, right ventricular dysfunction, gas exchange impairment, biomarker profile, and clinical evolution. SIAC is designed to enhance traditional risk stratification models by enabling serial bedside reassessment and facilitating early identification of patients at risk of clinical deterioration and adverse outcomes.

Modern management of acute PE requires a comprehensive and dynamic approach. This consensus integrates current evidence and proposes SIAC as a complementary tool to improve prognostic assessment and support more individualized therapeutic decision-making.