Pulmonary Embolism: Risk-Stratify & Treat

• AHA/ACC 2026 categories drive therapy: shock or arrest (Category E) → systemic lysis or other reperfusion; RV strain with a troponin rise (Categories C–D) → anticoagulate and escalate if worsening; low risk (Categories A–B) → anticoagulate, sometimes as outpatients.
• LMWH is preferred over UFH for initial anticoagulation (AHA/ACC 2026), with UFH kept for refractory shock or arrest, severe renal impairment or an urgent procedure; DOACs (apixaban/rivaroxaban) are first-line in stable patients.
• Give alteplase 100 mg over 2 h (50 mg bolus in arrest); reserve IVC filters for contraindicated anticoagulation.
• A deteriorating Category C–D PE calls for rescue reperfusion: catheter-directed therapy or systemic lysis.

First tests: Clinical pretest probability, 12-lead ECG, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: D-dimer, CT pulmonary angiography, Ventilation/perfusion imaging, Bedside echocardiography, Troponin and BNP/NT-proBNP, Venous compression ultrasound.

Repeat monitoring: Oxygenation, BP and perfusion.

• Workup of Suspected Acute Pulmonary Embolism (PE) in the Intensive
• Treating Confirmed Acute PE in the ICU