2026 ACC/AHA Guidelines for Acute Pulmonary Embolism

The ACC/AHA published new guidelines for managing acute PE on February 19, 2026. Today I'm joined by Dr. Scott Woller, MD, MACP, FCCP, who was co-chair of the American College of Chest Physicians Clinical Practice Guideline for antithrombotic therapy for venous thromboembolism, last updated in 2021. He also served as co-chair for the peer review committee for these new guidelines, and has lots of great insights into how to use them in clinical practice and research. 

2026 ACC/AHA Guidelines for Diagnosis and Managing Acute PE

Some highlights from the guidelines:

• New categories of PE: 
  • A: asymptomatic
  • B: symptomatic, low risk
  • C: symptomatic, high risk
  • D: incipient shock
  • E: cardiogenic shock
• PE response teams (PERTs) are ascendant
• Use enoxaparin instead of heparin drip!
• Advanced therapies for category D and E
• Half dose DOACs for extended treatment
• Shared decision making for clots provoked by minor risk factors
• Patients with persistent symptoms need evaluation for CTEPD

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