The American Heart Association and the American College of Cardiology have released the first clinical practice guideline on acute pulmonary embolism (PE), emphasizing early detection and prompt treatment. The guideline, published in Circulation and JACC, introduces a new Acute Pulmonary Embolism Clinical Category system to classify severity and guide treatment strategies. According to the American Heart Association's 2026 Heart Disease and Stroke Statistics, approximately 470,000 people are hospitalized with PE annually in the U.S., and about 1 in 5 high-risk patients die.
“There have been significant advances in the understanding of pulmonary embolism and treatments to effectively manage this condition,” said Mark A. Creager, M.D., chair of the guideline writing committee. “This guideline is a road map to help clinicians navigate these advances for the safest and most effective approaches to care.” The guideline details risk factors such as recent surgery, trauma, prolonged immobility, pregnancy, obesity, cancer, and blood clotting disorders. It recommends assessing patients for these factors to determine the probability of acute PE.
The new clinical classification system categorizes patients into five groups (A-E) based on symptom severity and risk of adverse outcomes. Categories A and B include low-risk patients who may be discharged from the emergency department, while Categories C-E require hospitalization and potentially advanced interventions. For diagnosis, the guideline recommends D-dimer testing in patients with low or intermediate probability, followed by computed tomography pulmonary angiography (CTPA) if indicated. For those unable to undergo CTPA, a lung ventilation/perfusion scan is advised.
Anticoagulants, particularly direct oral anticoagulants (DOACs), are the primary treatment for confirmed acute PE, preferred over warfarin due to safety and ease of use. However, DOACs are not recommended during pregnancy. For high-risk patients (Categories D-E), advanced treatments such as catheter-based clot removal or surgical embolectomy may be necessary. The guideline also addresses follow-up care, recommending early follow-up within one week of discharge and additional visits at three months and beyond to monitor for complications like chronic thromboembolic pulmonary disease (CTEPD).
Psychological health screening for depression, anxiety, and PTSD is encouraged, as these are common after acute PE. Physical activity, including walking early in recovery, is recommended. For travel, patients should move frequently and consider compression stockings on long trips. Women of childbearing age should receive counseling on contraception and pregnancy management. The guideline was developed in collaboration with eight other healthcare organizations, including the American College of Clinical Pharmacy and the Society for Vascular Medicine.
