Today, I link to, and excerpt from:
2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. J Am Coll Cardiol. 2026 Feb 19:S0735-1097(25)10161-7. doi: 10.1016/j.jacc.2025.11.005. Online ahead of print.
The above article is summarized in:
First AHA/ACC acute pulmonary embolism guideline: prompt diagnosis and treatment are key: A new clinical classification system to assess the severity of an acute pulmonary embolism, a condition in which a blood clot blocks the arteries in the lungs, and recommendations to guide treatment strategies are detailed in the new 2026 joint guideline from the American Heart Association and the American College of Cardioloy. DALLAS and WASHINGTON (Feb 19, 2026).
Early detection and prompt treatment of acute pulmonary embolism (PE), a sudden and potentially life-threatening blood clot that blocks arteries in the lungs, is critical. Comprehensive recommendations for the evaluation, management and follow-up care for adults with acute PE are detailed in this new clinical practice guideline, published today in the American Heart Association’s flagship peer-reviewed journal Circulation and in JACC, the flagship journal of the American College of Cardiology.
All that follows is from the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. J Am Coll Cardiol. 2026 Feb 19:S0735-1097(25)10161-7. doi: 10.1016/j.jacc.2025.11.005. Online ahead of print.
TABLE OF CONTENTS
3.1. Evaluation eXXX3.1.1. Clinical Assessment eXXX3.1.2. Diagnostic Testing eXXX4.4.1. Systemic Thrombolysis eXXX4.4.3. Mechanical Thrombectomy eXXX4.4.4. Surgical Embolectomy eXXXAbstract
Aim: The “2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults” is a de novo guideline that provides comprehensive recommendations for the evaluation, management, and follow-up of adult patients (≥18 years of age) with acute pulmonary embolism (acute PE). A key feature of this guideline is the introduction of the AHA/ACC Acute Pulmonary Embolism Clinical Categories, which enhance the precision of severity classification, prognosis assessment, and evidence-based therapeutic decision-making.
Methods: A comprehensive literature search was conducted from February 2024 to October 2024 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Select key studies published until April 2025 were added by the guideline writing committee as appropriate.
Structure: The focus of this clinical practice guideline is an evidence-based and patient-centered approach for acute PE evaluation and management of the adult patient. This guideline encompasses the period from the onset of symptoms through clinical follow-up, focusing on risk outcomes assessment, clinical diagnosis of acute PE, appropriate use of adjunctive cardiovascular testing, and management in both the acute and early post-acute phases of PE. It addresses evidence-based diagnostic and management strategies (including pharmacological therapies, advanced interventional therapies, and in-hospital support) for acute PE and associated outcomes.
Keywords: AHA/ACC clinical practice guideline; acute disease; acute pulmonary embolism; and venous thromboembolism; anticoagulant; chronic thromboembolic pulmonary hypertension; diagnosis; diagnostic imaging; direct acting oral anticoagulant; heparin; hypertension, pulmonary; imaging; kidney disease; kidney insufficiency; multimodal imaging; oral anticoagulants; perfusion imaging; pulmonary embolism; risk assessment; risk factors; risk stratification; thrombectomy; thromboembolism; thrombolytic therapy; tomography.
Copyright © 2026 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Top Take-Home Messages
1. A new clinical classification scheme is presented, entitled “Acute Pulmonary Embolism Clinical Categories,” with 5 categories (A-E) and subcategories, ranging from low to high risk for adverse outcomes, in order to enhance the precision of severity classification, prognosis assessment, and evidence-based therapeutic decision-making for patients presenting with acute PE.2. Patients with acute PE who are asymptomatic (AHA/ACC PE Category A) can safely be discharged home from the emergency room and do not need to be hospitalized.3. Early hospital discharge is generally recommended for patients with acute PE who are symptomatic but have a low clinical severity score (AHA/ACC PE Category B).4. Symptomatic patients with acute PE and an elevated clinical severity score, including those with elevated biomarkers and/or right ventricular dysfunction (AHA/ACC PE Category C), incipient cardiopulmonary failure (AHA/ACC PE Category D), and those with cardiopulmonary failure characterized by persistent hypotension (AHA/ACC PE Category E) should be hospitalized to optimize treatment strategies.5. Advanced therapies, including systemic thrombolysis, catheter-based thrombolysis, mechanical thrombectomy, and surgical embolectomy are reasonable for patients with acute PE in AHA/ACC PE Category E1 and can be considered for patients with acute PE in AHA/ACC PE Category D1-2.6. PE response teams (PERTs) are recommended to improve timeliness of care.7. In patients with acute PE who require initial parenteral anticoagulant therapy, low-molecular-weight heparin (LMWH) is recommended over unfractionated heparin (UFH).8. In patients with acute PE who are eligible for oral anticoagulation, direct oral anticoagulants (DOACs) are recommended over vitamin K antagonists (VKAs), unless contraindicated, to prevent recurrent venous thromboembolism (VTE) and reduce major bleeding.9. In patients with a first acute PE without a major reversible risk factor and in those with a persistent risk factor, continuing anticoagulation beyond the initial treatment phase (3-6 months) into the extended phase is recommended.10. Patients who have had acute PE should be asked about PE-related symptoms and functional limitations at every visit for at least 1 year to screen for chronic thromboembolic pulmonary disease (CTEPD) or other causes of dyspnea and functional limitation.
