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 today in Circulation and JACC, the guideline introduces a new Acute Pulmonary Embolism Clinical Category system to define the severity of an acute PE and assist in developing a treatment strategy for adults with this condition.
According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, approximately 470,000 people are hospitalized with PE in the U.S. annually, and about 1 in 5 high-risk patients die. Chair of the guideline writing committee Mark A. Creager, M.D, FAHA, FACC, a professor of medicine at the Geisel School of Medicine at Dartmouth College, emphasized the importance of the guideline: “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.”
The new Acute PE Clinical Categories classify patients into five categories (A-E) based on symptom severity and risk for adverse outcomes. Patients in Categories A and B often can be safely discharged from the emergency department, while Categories C-E require hospitalization. The guideline details risk factors for acute PE, including recent surgery, trauma, prolonged immobility, pregnancy, obesity, cancer, and blood clotting disorders.
For diagnosis, the guideline recommends D-dimer testing for patients with low or intermediate probability of PE, followed by computed tomography pulmonary angiography (CTPA) for those with elevated D-dimer or high probability. Anticoagulants are the primary treatment, with direct oral anticoagulants (DOACs) preferred over warfarin due to safety and ease of use. For patients in Categories D-E, advanced treatments such as catheter-based clot removal may be necessary.
Follow-up care is also addressed, including early follow-up within one week of discharge, a three-month visit to determine anticoagulation duration, and long-term monitoring for chronic thromboembolic pulmonary disease. The guideline also highlights the importance of screening for depression, anxiety, and post-traumatic stress disorder, which are common after acute PE.
The guideline was developed in collaboration with and endorsed by eight other health care organizations, including the American College of Clinical Pharmacy and the American College of Emergency Physicians. It is expected to improve outcomes by promoting rapid diagnosis and evidence-based treatments.
