Abstract
Background: Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality, with traditional management paradigms increasingly revealing their limitations. Objective: This article analyzes the updates in the 2026 AHA/ACC Guideline for the management of acute pulmonary embolism and evaluates the feasibility of their application in Vietnam. Methods: A synthesis of the 2026 Guideline was conducted, comparing it with previous guidelines (2011 AHA, 2019 ESC) and foundational clinical trials to propose practical strategies. Results: The 2026 Guideline shifts towards evaluating PE based on pathophysiology and right ventricular function with four core updates: (1) Utilizing the A-E clinical classification system instead of legacy risk models; (2) Optimizing diagnostic algorithms (integrating YEARS criteria and age-adjusted D-dimer); (3) Reaffirming DOACs as the first-line therapy; (4) Expanding indications for catheter-directed interventions (CDT), mechanical thrombectomy, VA-ECMO, and formalizing the Pulmonary Embolism Response Team (PERT) as a Class I recommendation. Conclusion: The guideline establishes a new standard. In Vietnam, implementing the A-E classification and the PERT model is the most feasible and effective priority before investing in high-tech interventions
