AHA/ACC 2026 Acute PE Guideline: A–E Classification & DOAC Preference

A joint American Heart Association/American College of Cardiology guideline for adults with acute pulmonary embolism (PE) introduces five Acute PE Clinical Categories (A–E) based on symptom severity and risk for adverse outcomes.

The press release notes that the guideline includes treatment recommendations by care setting (e.g., discharge/outpatient management vs hospitalization vs critical care) and that use of this disposition-oriented framework depends on local resources, including access to specialists, imaging, and advanced interventions. In the same announcement, the organizations describe the document as pairing the new categorization with diagnostic and treatment pathways, along with follow-up planning for adults diagnosed with acute PE.

In the release’s description, Categories A and B reflect patients with no or mild symptoms and a lower-risk profile; it states these patients often can be discharged from the emergency department and managed as outpatients. By contrast, the press release describes Categories C through E as higher-risk groups that require hospitalization. It adds that patients in Categories D–E may need advanced treatments and procedures, such as intravenous or catheter-based thrombolytic therapy, mechanical clot removal, or surgical removal. Across the A–E scheme, the organizing idea is to align clinical presentation and risk with a care environment that can support evaluation and management.

For suspected acute PE, the press release summarizes a stepwise diagnostic approach that begins with estimation of pretest probability based on symptoms, risk-factor assessment, and physical examination. It describes D-dimer testing for patients categorized as having low or intermediate pretest probability, noting that normal D-dimer levels make PE unlikely in that context. When D-dimer is elevated or clinical probability is considered high, the press release describes imaging to look for PE as the next step. Computed tomography pulmonary angiography (CTPA) is described as the standard imaging test to diagnose or rule out acute PE, with ventilation–perfusion (V/Q) scanning described as an alternative when CTPA cannot be performed.

On treatment strategy, the press release describes anticoagulants as the primary treatment for patients with confirmed acute PE. It reports that direct oral anticoagulants (DOACs)—rivaroxaban, apixaban, edoxaban, and dabigatran—are recommended over vitamin K antagonists such as warfarin for eligible patients to prevent recurrent blood clots, citing safety, ease of use, and a reduced risk of major bleeding. The release also states an explicit exception: DOACs are not recommended during pregnancy due to potential fetal risks. In pregnancy, it describes low-molecular-weight heparin or unfractionated heparin as options that can be used for acute PE.

For people discharged after acute PE, the press release summarizes a follow-up cadence that begins with communication or a clinic visit within one week of hospital discharge, covering the treatment plan, medication use as prescribed, and assessment for bleeding complications. It also describes an additional clinic visit by three months after diagnosis to help determine how long anticoagulant therapy will continue, assess the need for further testing, and evaluate ongoing symptoms. Longer-term monitoring is framed around screening, at every visit for at least one year, for symptoms or functional limitations suggestive of chronic thromboembolic pulmonary disease (CTEPD). For patients continuing anticoagulation beyond three to six months, the release notes periodic reassessment of the risks and benefits of continued therapy, and it also highlights follow-up considerations spanning psychological health, physical activity, travel precautions, and contraception/pregnancy counseling.

Key Takeaways:

• The press release describes an A–E acute PE categorization intended to link patient classification with suggested care settings while noting that implementation is shaped by local resources.
• The reported diagnostic sequence starts with pretest probability assessment, uses D-dimer testing in low/intermediate probability, and centers CTPA as standard imaging, with V/Q scanning when CTPA cannot be performed.
• The release reports a preference for DOACs over vitamin K antagonists in eligible patients, names pregnancy as an exception with heparin-based options, and outlines early and longer-term follow-up time points including CTEPD screening.