Guideline Highlights:
Embargoed until 1:00 p.m. CT/2:00 p.m. ET Thursday, Feb. 19, 2026
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 .
A PE is a blood clot that typically originates in a deep vein in the leg or pelvis, travels through the heart and becomes lodged in an artery in the lungs. It is part of a condition known as venous thromboembolism (VTE). Acute PE can lower oxygen levels in the blood, damage lung tissue and put serious strain on the heart, making it a potentially fatal medical emergency. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics , approximately 470,000 people are hospitalized with PE in the U.S. annually, and approximately 1 in 5 high-risk patients die.
“There have been significant advances in the understanding of pulmonary embolism and treatments to effectively manage this condition,” said Chair of the guideline writing committee Mark A. Creager, M.D, FAHA, FACC, a professor of medicine at the Geisel School of Medicine at Dartmouth College in Hanover New Hampshire, and director emeritus of the Heart and Vascular Center at Dartmouth Health in Lebanon, New Hampshire. “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” he said.
The new guideline includes patient treatment recommendations by care setting, including which patients can be discharged from the emergency department and managed as outpatients; which patients require hospitalization; and which patients need critical care. It also acknowledges that implementation of the recommendations depends on the availability of local resources, such as specialists for consultations, imaging tests and advanced interventions.
New clinical classification system
New Acute PE Clinical Categories are introduced to classify patients with acute PE into five categories (A-E), based on their severity of symptoms and risk for adverse outcomes. Patients in Categories A and B have no or mild symptoms and low risk of experiencing severe complications; they often can be safely discharged from the emergency department. Categories C-E include people with symptoms of acute PE who are at higher risk of adverse outcomes and require hospitalization (chart available under resources).
Risk factors associated with acute PE
Prompt diagnosis of acute PE is essential for timely treatment, which can prevent severe complications such as cardiac arrest and death. However, timely diagnosis of acute PE is often challenging because many symptoms, such as shortness of breath, chest pain, rapid heartbeat, fainting and/or dizziness, are similar to symptoms for of other conditions.
Factors that damage the veins or reduce blood flow, or conditions that promote the likelihood of clot formation, can increase the risk of VTE. When considering the probability of acute PE, clinicians should assess patients for factors that increase the risk for clotting, including:
Laboratory and diagnostic testing
In patients who have a low or intermediate probability (<50%) of acute PE based on symptoms, risk factor assessment and physical examination, a blood test should be obtained to measure D-dimer, a protein fragment released into the blood when the body breaks down a clot. Patients with normal levels of D-dimer are unlikely to have a pulmonary embolism. If the D-dimer level is elevated, or if the clinical probability of acute PE is deemed high (>50%), imaging to look for a PE is recommended.
Computed tomography pulmonary angiography (CTPA) is the standard imaging test to diagnose or rule out acute PE. It is highly accurate, stand-alone imaging to find and visualize the location and size of the blood clot, and is widely available in emergency rooms across the country. People who cannot undergo CTPA (for example, patients with an allergy or reaction to iodine-based contrast dye) should be screened for acute PE with a lung ventilation/perfusion scan (a type of nuclear imaging test).
Treatment strategies
Anticoagulants (medications that prevent blood clots from forming) are the primary treatment recommended for patients with confirmed acute PE. Direct oral anticoagulants (DOACs), such as rivaroxaban, apixaban, edoxaban or dabigatran, are recommended over vitamin K antagonists, such as warfarin, to prevent recurrent blood clots, due to their safety, ease of use and reduced risk of major bleeding. DOACs are not recommended during pregnancy due to potential risks to the fetus. Low-molecular-weight heparin or unfractionated heparin can be safely used for acute PE during pregnancy.
Patients with acute PE in Categories D-E may need advanced treatments and procedures, including intravenous or catheter-based administration of a clot dissolving drug, catheter-based mechanical removal of the blood clot(s) or surgical removal of the blood clot(s). The guideline also details appropriate sedation, ventilation and mechanical circulatory support to maintain heart and lung function for critically ill patients with acute PE.
Considerations for follow-up management
Follow-up communication and clinic visits are recommended:
Additional considerations for follow-up care include:
“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.
The guideline, led by the American Heart Association and the American College of Cardiology Joint Committee on Clinical Practice Guidelines, was developed in collaboration with and endorsed by eight other health care organizations: the American College of Clinical Pharmacy; the American College of Emergency Physicians; the American College of Chest Physicians; the Society for Cardiovascular Angiography & Interventions; the Society of Hospital Medicine; the Society of Interventional Radiology; the Society for Vascular Medicine; and the Society of Vascular Nursing. American Heart Association/American College of Cardiology.
Co-authors and members of the guideline writing committee are Co-Vice Chairs Geoffrey D. Barnes, M.D., M.Sc., FAHA, FACC, and Jay Giri, M.D., M.P.H., FAHA, FACC; Debabrata Mukherjee, M.D., M.S., FAHA, FACC; William Schuyler Jones, M.D., FACC; Allison E. Burnett, Pharm.D., Ph.C.; Teresa Carman, M.D.; Ana I. Casanegra, M.D., M.S., FAHA; Lana A. Castellucci, M.D., M.Sc.; Sherrell M. Clark; Mary Cushman, M.D., M.Sc., FAHA; Kerstin de Wit, M.B.Ch.B., M.Sc., M.D.; Jennifer M. Eaves, D.N.P., M.S.N., R.N.; Margaret C. Fang, M.D., M.P.H.; Joshua B. Goldberg, M.D.; Stanislav Henkin, M.D, FAHA, FACC; Hillary Johnston-Cox, M.D., FACC; Sabeeda Kadavath, M.D., FACC; Daniella Kadian-Dodov, M.D., FAHA, FACC; William Brent Keeling, M.D., FACC; Andrew J.P. Klein, M.D., FACC; Jun Li, M.D.; Michael C. McDaniel, M.D., FACC; Lisa K. Moores, M.D.; Gregory Piazza, M.D., M.S., FAHA, FACC; Karen S. Prenger, M.S., A.P.R.N.-C.N.S.; Steven C Pugliese, M.D.; Mona Ranade, M.D; Rachel P. Rosovsky, M.D, M.P.H.; Farla Russo; Eric A. Secemsky, M.D., M.Sc., FAHA, FACC; Akhilesh K. Sista, M.D., FAHA; Leben Tefera, M.D., FACC; Ido Weinberg, M.D., FACC; Lauren M. Westafer, D.O., M.P.H., M.S.; and Michael N. Young, M.D., FACC. Authors’ disclosures are listed in the manuscript.
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About the American Heart Association
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About the American College of Cardiology
The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or follow @ACCinTouch
Circulation
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