Clinical Decision Support. Based on 2026 AHA/ACC Acute PE Guidelines. For educational support only. Always apply clinical judgement.
Quick Actions
🔴 Patient Assessment
Haemodynamics → Wells/PERC → Imaging → sPESI → A–E Category → Management
📊 A–E Category Reference
Full 2026 AHA/ACC classification with management plans
🩸 Anticoagulation Reversal
Reversal agents · Major bleeding protocol · Restart guidance
📅 Post-PE Follow-Up
Duration · CTEPH surveillance · Thrombophilia screening
2026 Key Changes
- A–E classification replaces massive / submassive / low-risk
- R modifier for respiratory compromise appended to any category
- PERT teams upgraded to Class I for Cat C3, D, E
- DOACs preferred over warfarin (Class I) · LMWH over UFH
- Category A (incidental PE) — discharge directly from ED
- First-ever dedicated AHA/ACC PE clinical practice guideline
PE Manager v1.0 · Last reviewed May 2026
FOR EDUCATIONAL USE ONLY · NOT A REGULATED MEDICAL DEVICE
Not validated for paediatric use · Always verify doses locally
FOR EDUCATIONAL USE ONLY · NOT A REGULATED MEDICAL DEVICE
Not validated for paediatric use · Always verify doses locally
① Haemo
② Wells/PERC
③ Imaging
④ sPESI
⑤ RV/Bio
⑥ A–E
⑦ Mgmt
Step 1 — Haemodynamic Status
Check FIRST. Instability = Category D/E → immediate action. Do not delay for scoring tools.
Is the patient haemodynamically UNSTABLE?
SBP <90 mmHg · Shock · Syncope · Cardiac arrest · Signs of RV failure
← Back
Step 2 — Wells Score & PERC Rule
📊 Wells Score
🔵 PERC Rule
Clinical signs/symptoms of DVT
+3
PE is #1 diagnosis OR equally likely
+3
Heart rate >100 bpm
+1.5
Immobilisation ≥3 days OR surgery in past 4 weeks
+1.5
Prior DVT or PE
+1.5
Haemoptysis
+1
Malignancy (on treatment or past 6 months)
+1
0
Score: 0
Low probability → Apply PERC Rule
→ Switch to PERC checklist
← Back
Step 3 — Imaging Decision & Results
🧪 D-Dimer Result
Use only in low–moderate pre-test probability (Wells ≤4)
Standard cutoff: <0.5 mg/L
Age-adjusted (≥50): Age × 10 µg/L
Sensitivity: 97%
NPV: ~99%
🔬 CTPA Result
Gold standard · Sensitivity 94% · Specificity 98%
☢️ V/Q SPECT Result
When CTPA contraindicated · Sensitivity 92% · Specificity 91%
← Back
Step 4 — sPESI Score (Post-confirmation)
Use after PE is confirmed. sPESI directly determines A–E category assignment.
Age >80 years
+1
Cancer (active malignancy)
+1
Chronic cardiopulmonary disease
+1
Heart rate ≥110 bpm
+1
SBP <100 mmHg
+1
SpO₂ <90%
+1
0
sPESI = 0 — LOW RISK
30-day mortality ~1% · Likely Category B
← Back
Step 5 — RV Function & Biomarkers
These findings determine C1/C2/C3 subcategory and R modifier. Tick all that apply.
🫀 RV Dysfunction (Echo / CT)
Either criterion = RV dysfunction present
RV/LV ratio >0.9 (echo) or >1.0 (CT)
TAPSE <16 mm or McConnell's sign positive
2.5×
Mortality if RV/LV >0.9
72%
TAPSE sensitivity
🧪 Cardiac Biomarkers
Either criterion = biomarker elevation present
Troponin elevated — TnI >0.1 ng/mL or hs-Tn >14 pg/mL
BNP >100 pg/mL or NT-proBNP >600 pg/mL
98%
hs-Tn NPV if <14 pg/mL
600
NT-proBNP cutoff (pg/mL)
🫁 Respiratory Criteria (R Modifier)
If ticked → R modifier applied to any category
SpO₂ <90% on room air or escalating supplemental O₂ needs
Tachypnoea / respiratory distress
← Back
Step 5 — Assign A–E Category
3 questions → exact AHA/ACC 2026 category + management plan.
Question 1 of 3
Was PE found incidentally?
On CT done for another reason — no symptoms attributable to PE
← Back
Step 6 — Management Plan
Complete Step 5 (A–E Category) first to load the management plan.
A–E Category Reference — 2026 AHA/ACC
A
Subclinical
Incidental · Asymptomatic
B
Low Severity
sPESI 0 · No RV dysfn
C
Elevated Severity
sPESI ≥1 · C1/C2/C3
D
Incipient Failure
Pre-shock · ↑ lactate
E
Cardiopulmonary Failure
E1: Shock · E2: Arrest / refractory failure
R Modifier
Append R to any category when hypoxia / tachypnoea / escalating O₂ present. Does not change letter — forces higher monitoring level and prevents early discharge.
Parenteral
DOACs
Thrombolytics
Special Pop.
LMWH preferred over UFH — Class I, 2026 AHA/ACC. UFH for: CrCl <30, pre-thrombolysis, instability.
Enoxaparin PREFERRED
LMWH · Factor Xa inhibitor · SC
Treatment q12h
1 mg/kg SCcap 120 mg/dose
Treatment q24h
1.5 mg/kg SCcap 180 mg
Anti-Xa target (if needed)
0.6–1.0 IU/mL4h post-dose
UFH
Unfractionated heparin · IV infusion · Cat D–E
IV bolus
80 U/kgmax 10,000 U
Infusion
18 U/kg/hr
Target aPTT
60–80 sec
Fondaparinux
Selective anti-Xa · SC OD · Useful in HIT
<50 / 50–100 / >100 kg
5 / 7.5 / 10 mg
Anticoagulation Reversal
Major bleeding = Medical emergency. Stop anticoagulant. IV access ×2. Call haematology. Activate major haemorrhage protocol.
Reversal Agents
Protocol
Restart AC
Andexanet Alfa Anti-Xa DOACs
Reverses: Rivaroxaban · Apixaban · Edoxaban
Low dose (last dose >8h or ≤10 mg riv)
400 mg bolus + 480 mg/2h
High dose (recent or large dose)
800 mg bolus + 960 mg/2h
Idarucizumab (Praxbind) Dabigatran
Specific antidote · Reverses dabigatran only
Dose
5 g IV (2 × 2.5 g vials, 5–10 min)
Protamine Sulphate UFH/LMWH
Reverses UFH fully · LMWH partially (~60–80%)
UFH reversal
1 mg per 100 U UFH given in last 2h
Enoxaparin (<8h since dose)
1 mg per 1 mg enoxaparin
Max single dose
50 mg IV over 10 min
4-Factor PCC (Beriplex / Octaplex) Warfarin
Also used for DOAC life-threatening bleed if antidote unavailable
INR 2.0–3.9
25 IU/kg IV
INR 4.0–6.0
35 IU/kg IV
INR >6.0
50 IU/kg IV
Plus Vitamin K
5–10 mg IV
Tranexamic Acid Adjunct
Loading
1 g IV over 10 min
Maintenance
1 g IV over 8h
Post-PE Follow-Up
Guides management after acute phase resolved and patient stable on anticoagulation.
Timeline
AC Duration
CTEPH
Thrombophilia
Discharge
Anticoagulation started
Confirm before discharge
Patient education
Bleeding signs, PE recurrence, compliance
Written information
Anticoagulation booklet + emergency card
1–2 Weeks (Cat A) · 5–7 Days (Cat B)
Review compliance
Compliance, bleeding, renal function
Bloods
FBC, U&E, LFTs baseline
3 Months
Duration decision
Provoked → consider stopping · Unprovoked → reassess
Thrombophilia screen
If indicated — see Thrombophilia tab
Symptom review
Persistent dyspnoea? → CTEPH screen
6 Months
Echo
If dyspnoea persists → exclude CTEPH
Malignancy screen
If unprovoked: CT CAP, PSA/CA125
About PE Manager
🫁
PE Manager
Clinical Decision Support
v1.0
May 2026
2026 AHA/ACC
📚 Clinical References
[1]2026 AHA/ACC/ACCP/ACEP Clinical Practice Guideline for Acute PE — First dedicated AHA/ACC PE guideline
[2]2019 ESC Guidelines on Acute PE (Konstantinides SV et al., Eur Heart J 2020)
[3]AMPLIFY — Apixaban for VTE (Agnelli G et al., NEJM 2013)
[4]EINSTEIN-PE — Rivaroxaban for PE (EINSTEIN Investigators, NEJM 2012)
[5]Hokusai-VTE — Edoxaban (Büller HR et al., NEJM 2013)
[6]CLOT — Dalteparin in cancer VTE (Lee AY et al., NEJM 2003)
[7]TRAPS — Rivaroxaban vs Warfarin in APS (Pengo V et al., NEJM 2018)
[8]Wells PE Score (Wells PS et al., Ann Intern Med 2001)
[9]PERC Rule (Kline JA et al., J Thromb Haemost 2004)
[10]sPESI (Jiménez D et al., Eur Respir J 2010)
⚠️ Limitations
- Not a regulated medical device (MHRA / FDA / CE)
- No formal clinical validation studies performed
- Not validated for paediatric patients (under 18)
- Dose calculations are guidance — always verify locally
- Local protocols may differ from 2026 AHA/ACC recommendations
- Check for app updates — guidelines evolve
📞 Local Emergency Contacts
Update with your department numbers
🚨
PERT On-Call
Tap to set local PERT number
🔴
Haematology On-Call
Tap to set local haematology number
💙
Cardiology / ECMO
Tap to set local number
📋 Legal & Compliance
PE Manager v1.0 · Last reviewed May 2026
Based on 2026 AHA/ACC Acute PE Guidelines
FOR EDUCATIONAL USE ONLY · NOT A REGULATED MEDICAL DEVICE
Not validated for paediatric use · Always verify doses locally
Based on 2026 AHA/ACC Acute PE Guidelines
FOR EDUCATIONAL USE ONLY · NOT A REGULATED MEDICAL DEVICE
Not validated for paediatric use · Always verify doses locally