Last Week in Medicine 2026 ACC/AHA Guidelines for Acute Pulmonary Embolism
Mar 11, 2026
Scott Woller, research professor and thrombosis expert who helped shape the 2026 ACC/AHA pulmonary embolism guidelines. He describes a new A–E PE classification, the rise of PE response teams, preference for enoxaparin over heparin drip, expanded advanced catheter and thrombectomy options, and guidance on half-dose DOACs for extended therapy.
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New A Through E PE Severity Categories
- The ACC/AHA introduced an acute PE clinical category system A through E to standardize severity and guide therapy.
- Category C (symptomatic high severity) through E (cardiogenic shock) include subcategories (eg C3R) combining RV dysfunction, biomarkers, and respiratory modifier.
C3R Translates Intermediate High Risk Into Clear Labels
- The guideline maps older terms (intermediate‑high risk) into precise category labels like C3R for research and treatment clarity.
- Example: intermediate‑high (RV strain + positive biomarker) becomes C3 with an R respiratory modifier if SaO2 <90% or tachypnea.
Use Risk Scores But Reassess Frequently
- Use validated risk scores (eg PESI, NEWS, Bova) to identify higher short‑term risk in C and D patients but recognize none predict perfectly.
- Prioritize close serial reassessment and monitor patients in locations where deterioration can be detected quickly.