AHA and ACC Release First Guideline for Pulmonary Embolism Treatment

On February 19, 2026, the American Heart Association (AHA) and the American College of Cardiology (ACC) released the first clinical practice guidelines on the treatment of acute pulmonary embolism (PE), detailing risk factors and recommending treatment and follow-up after diagnosis.1

“There have been significant advances in the understanding of pulmonary embolism and treatments to effectively manage this condition,” Mark Creager, MD, FACC, professor of medicine at the Geisel School of Medicine at Dartmouth College, director emeritus of the Heart and Vascular Center at Dartmouth Health, and chair of the guideline writing committee, said in a statement. “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.”1

The guidelines’ key takeaways, as listed by the investigator committee, are as follows:

• Patients with acute PE who are asymptomatic can be safely discharged home. Early hospital discharge is also recommended for patients with acute PE who are symptomatic but have a low clinical severity score.
• Symptomatic patients with acute PE and an elevated clinical severity score should be hospitalized to optimize treatment strategies. This includes those with elevated biomarkers and/or right ventricular dysfunction, cardiopulmonary failure with persistent hypotension, and incipient cardiopulmonary failure.
• Low-molecular-weight heparin (LMWH) is recommended rather than unfractionated heparin (UFH) in patients with acute PE who need initial parental anticoagulant therapy.
• Patients with acute PE eligible for oral anticoagulation should be given direct oral anticoagulants (DOACs) over vitamin K antagonists, unless contraindicated. These will prevent recurrent venous thromboembolism and reduce major bleeding.
• Patients with a first acute PE without a major reversible factor or with a persistent risk factor, continuing anticoagulation beyond the initial treatment phase of 3-6 months is recommended.
• Patients with acute PE in AHA/ACC PE Category E1 should receive advanced therapies like systemic thrombolysis, catheter-based thrombolysis, mechanical thrombectomy, and surgical embolectomy. These treatments should also be considered for patients in AHA/ACC PE Category D1-2.
• Patients who have had acute PE should regularly be asked about related symptoms and functional limitations at every clinic visit for ≥1 year to screen for causes of dyspnea and functional limitation like chronic thromboembolic pulmonary disease (CTEPD).2

Additionally, the team highlighted factors that damage the veins or reduce blood flow, promoting the likelihood of clot formation and thereby increasing the risk of venous thromboembolism. These include prolonged immobility, pregnancy and postpartum within 6 weeks of delivery, use of oral contraceptives or estrogen treatment, obesity, smoking, atherosclerotic cardiovascular disease, and cancer, among others.1

Patients with low or intermediate probability of acute PE based on symptom analysis should undergo a blood test for the measurement of D-dimer – elevated levels of this protein can signal the need for imaging to look for signs of a PE. The guidelines recommend computed tomography pulmonary angiography (CTPA) given its high accuracy and availability. For patients incapable of undergoing CTPA, the guidelines recommend screening via a lung ventilation/perfusion scan.1,2

Additionally, the guidelines highlight the need for follow-up after treatment, including both physical and psychological aspects of care. The authors note depression, anxiety, and post-traumatic stress disorder as common in patients who have experienced acute PE. Physical activity and limiting long-distance travel are also encouraged to minimize the risk of further clotting.2

“We anticipate that decisions guided by these recommendations will result in more rapid diagnosis and application of effective, evidence-based treatments, leading to better outcomes, such as decreased risk of death and disability, for people with acute pulmonary embolism,” Creager said.1

References

1. American Heart Association. First AHA/ACC acute pulmonary embolism guideline: prompt diagnosis and treatment are key. Eurekalert. February 19, 2026. Accessed February 20, 2026. https://www.eurekalert.org/news-releases/1116906

2. Creager MA, Barnes GD, Giri J, et al. 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. Circulation. Published online February 19, 2026. doi:10.1161/cir.0000000000001415