In addition to today’s resource, please review 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]. Circulation. 2026 Mar 24;153(12):e977-e1051. doi: 10.1161/CIR.0000000000001415. Epub 2026 Feb 19.
Today, I review, link to, excerpt from, and embed The Curbsiders‘ podcast “#544: Updated Pulmonary Embolism Guidelines”. October 26, 2026 | By Edison Jyang
All that follows is from the above resource.
Oct 26, 2026 Full EpisodesTranscript available via YouTube
Review the latest 2026 AHA/ACC multisociety pulmonary embolism guidelines with us, including risk stratification, new clinical categories, acute and extended anticoagulation, advanced therapies, follow-ups, and more. We are joined by Drs. Cyrus Askin and Nick Mark from Critical Care Time!
Claim CME for this episode here: https://ce.vcuhealth.org/curbsiders!
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Show Segments
- Intro
- Initial assessment and diagnostic approach to PE
- Evolution of PE classification systems
- Acute PE treatment
- Advanced therapies
- Duration of anticoagulation
- Post-discharge follow-up
- Chronic thromboembolic disease
- Outro
Disclosures
Dr. Cyrus Askin reports financial disclosures with Astra Zeneca, Speakers Bureau. The Curbsiders report no relevant financial disclosures.
CME Partner: VCU Health CE
Updated Pulmonary Embolism Guidelines Pearls
- The YEARS algorithm *[Link is to the results of a Google Search web page] can help reduce unnecessary imaging by further guiding D-dimer interpretation. *Seen also Updated Review of the YEARS Algorithm for Pulmonary Embolism (PE) from Evidence to Action: Official Journal of MDCalc Clinical Decision Tool Reviews.
- Low-molecular-weight heparin (LMWH) is recommended over unfractionated heparin for initial parenteral therapy for PE management (class 1B recommendation).
- Half-dose apixaban and rivaroxaban for extended anticoagulation therapy for PE receives a class 1A recommendation to reduce bleeding risk.
- Post-PE follow-ups at 1 week and 3 months are important to assess clinical recovery, anticoagulant adherence, bleeding risk, and persistent symptoms.
- If chronic thromboembolic pulmonary disease is suspected, a ventilation-perfusion (V/Q) scan is the preferred screening test.
Updated Pulmonary Embolism Guidelines Notes
Risk Stratification and Diagnostic Tools
A pulmonary embolism (PE) should be suspected in patients with acute dyspnea, pleuritic chest pain, tachycardia, tachypnea, unilateral leg swelling, or relevant venous thromboembolism (VTE) risk factors (e.g. recent prolonged travel, surgery, or immobilization). Assess pretest probability to guide testing and avoid unnecessary imaging, radiation, contrast exposure, and cost.
Use a validated tool such as the Wells score or Geneva score to estimate pretest probability. In patients with very low clinical suspicion, the PERC rule can exclude PE without further testing if all criteria are negative. For low- or intermediate-probability patients, D-dimer testing using an age-adjusted threshold or the YEARS algorithm can safely reduce unnecessary imaging. Patients with high clinical probability should generally proceed directly to a computed tomography pulmonary angiogram (CTPA).
YEARS is emphasized in the 2026 AHA/ACC guidelines as an additional evidence-based strategy to guide D-dimer testing and avoid unnecessary imaging. It uses three criteria: clinical signs of DVT, hemoptysis, and PE being the most likely diagnosis. PE can be excluded with a D-dimer below 1,000 ng/mL when no YEARS criteria are present, or below 500 ng/mL when one or more criteria are present. The pregnancy-adapted YEARS algorithm can also be used in appropriately selected pregnant patients to reduce unnecessary imaging.
