Ep. 37 Breaking Down the New Pulmonary Embolism Guidelines with Dr. Sanjum Sethi

Are the latest pulmonary embolism guidelines changing how you risk-stratify and intervene on acute PE? In this episode of BackTable Cardiology, host Dr. Hady Lichaa interviews Dr. Sanjum Sethi of Columbia University Medical Center about the evolving management of pulmonary embolism (PE) and the major updates reflected in the newest guidelines. They review the new A–E risk classification system, key updates to systemic thrombolysis recommendations, and the expanding role of catheter-based therapies as randomized evidence emerges, highlighting how these changes are shaping PERT protocols, influencing clinical decision-making, and affecting patient outcomes. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction01:40 - Major Guideline Changes 13:26 - Essential Components of PERT Calls16:38 - Assessing Clot Burden24:32 - When To Prioritize Surgical Management30:15 - Importance of RV Function 31:26 - Heparin Versus LMWH 37:58 - TPA Dosing 43:42 - Thrombectomy Devices And Guidelines50:19 - Future Technology --- More about this episode The doctors discuss key practice updates, including the new Class I recommendation to incorporate lactate into shock assessment and the downgrade of systemic thrombolysis for highest-risk PE patients while highlighting the expanding evidence and indications for catheter-based therapies. Dr. Sethi outlines the essential clinical data to gather during PERT calls, including vital signs, RV function, biomarkers, and patient goals, and explains why relying solely on CT thrombus burden can be misleading. They discuss the importance of echocardiography for detecting findings like PFO or clot-in-transit and provide guidance on when to consider surgical intervention or ECMO, how to choose between heparin and LMWH, and the nuanced decision-making behind selecting catheter-directed thrombolysis versus mechanical thrombectomy. --- Resources Dr. Hady Lichaa’s Provider Profilehttps://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Dr. Sanjum Sethi’s Provider Profilehttps://www.columbiacardiology.org/profile/sanjum-s-sethi-md-mph 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adultshttps://www.ahajournals.org/doi/10.1161/CIR.0000000000001415?utm_campaign=sciencenews25-26&utm_source=science-news&utm_medium=phd-link&utm_content=phd-2-19-26 Pharmacomechanical Catheter-Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism: The RESCUE Study https://www.jacc.org/doi/10.1016/j.jcin.2022.09.011 --- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app