The American Heart Association and the American College of Cardiology have released the first clinical practice guideline on acute pulmonary embolism (PE), a sudden and potentially life-threatening blood clot that blocks arteries in the lungs. Published simultaneously in Circulation and JACC, the guideline introduces a new Acute Pulmonary Embolism Clinical Category system to classify patients into five categories (A through E) based on symptom severity and risk of adverse outcomes, guiding treatment strategies from outpatient management to critical care.
Acute PE affects approximately 470,000 people annually in the U.S., and about 1 in 5 high-risk patients die, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics. Early detection and prompt treatment are critical to reduce mortality and complications. The guideline details risk factors such as recent surgery, hospitalization, trauma, prolonged immobility, pregnancy, obesity, cancer, and blood clotting disorders, which clinicians should assess when evaluating patients for PE.
For diagnosis, the guideline recommends D-dimer blood testing in patients with low or intermediate probability of PE. If D-dimer is elevated or clinical probability is high, computed tomography pulmonary angiography (CTPA) is the standard imaging test. For patients unable to undergo CTPA, a lung ventilation/perfusion scan is recommended.
Treatment primarily involves anticoagulants, with direct oral anticoagulants (DOACs) like rivaroxaban, apixaban, edoxaban, or dabigatran preferred over warfarin due to lower major bleeding risk. During pregnancy, low-molecular-weight heparin or unfractionated heparin is recommended. For higher-risk patients (Categories D-E), advanced interventions such as catheter-based clot removal or surgical embolectomy may be necessary.
Follow-up care is crucial: early follow-up within one week of discharge, a three-month visit to reassess anticoagulation duration, and long-term monitoring for chronic thromboembolic pulmonary disease (CTEPD). The guideline also addresses psychological health, encouraging screening for depression and anxiety, and advises early physical activity and travel precautions, such as using compression socks during long-haul travel.
“This guideline is a road map to help clinicians navigate these advances for the safest and most effective approaches to care for people with this condition,” said Mark A. Creager, M.D., FAHA, FACC, chair of the guideline writing committee. The guideline was developed in collaboration with eight other healthcare organizations, including the American College of Emergency Physicians and the Society for Vascular Medicine.
