2026 AHA/ACC
PE Manager
Clinical Decision Support · v1.0 · 2026 AHA/ACC Guidelines
⚠️ Read carefully before using this tool. This is a clinical decision support application. It does not replace professional medical judgement, training, or experience.
👨‍⚕️ Terms of Use for Clinicians
1. Nature of this tool. PE Manager is a clinical decision support tool based on the 2026 AHA/ACC Acute Pulmonary Embolism Clinical Practice Guidelines. It is intended to assist qualified healthcare professionals in the assessment and management of pulmonary embolism. It is not a substitute for clinical training, experience, or judgement.

2. Clinical responsibility. All clinical decisions remain the sole responsibility of the treating clinician. This application does not make diagnoses or prescribe treatments. Every recommendation presented must be reviewed, verified, and adapted to the individual patient by a qualified clinician.

3. Not a regulated medical device. This tool has not been approved or cleared as a medical device by the MHRA, FDA, CE, or any other regulatory body. It is provided for educational and decision support purposes only.

4. Accuracy and currency. While every effort has been made to ensure accuracy at the time of publication (May 2026), guidelines evolve and local protocols may differ. Always verify doses and recommendations against your institution's current formulary and local guidelines.

5. No patient data stored. This application does not collect, store, or transmit any patient identifiable information. All calculations are performed locally on your device.

6. Special populations. Always exercise heightened caution when using this tool for patients who are pregnant, paediatric (under 18), have severe renal impairment, or have complex comorbidities. This tool is not validated for paediatric use.

7. Drug doses. All drug doses are guidance only. Weight-based calculations are approximate. Always verify doses independently before prescribing, particularly in renal impairment, obesity, pregnancy, and extreme body weights.

8. Limitation of liability. The developers of this application accept no liability for clinical decisions made using this tool. Use of this application constitutes acceptance of full professional responsibility for all clinical decisions made.

9. Reporting errors. If you identify an error or outdated information, please report it using the feedback function within the app. Do not continue to use any section you believe to be inaccurate.
🧑‍🤝‍🧑 Information for Patients
This app is for healthcare professionals only. If you are a patient or member of the public accessing this tool, please be aware of the following:

Not for self-diagnosis. This tool is not designed for use by patients to assess or manage their own medical conditions. Do not use it to make decisions about your own health or medication.

Medical emergency. If you or someone with you is experiencing a medical emergency — including sudden breathlessness, chest pain, collapse, or rapid heartbeat — call 999 (UK) / 112 (EU) / 911 (US) immediately.

Your data. This application does not collect any personal or identifiable information about patients. No data entered into this app is stored or transmitted anywhere.

Questions about your care. If you have questions about PE treatment you are receiving, please speak directly with your treating doctor or nurse. They are best placed to explain your individual management plan.
🔒 Data & Privacy
No data collection. PE Manager does not collect, store, process, or transmit any personal data, patient data, or usage analytics. All computations occur entirely on your local device.

Cookies. This application uses only a single local storage item to record that you have accepted these terms. No tracking cookies are used.

GDPR / UK GDPR. Because no personal data is processed, GDPR obligations do not apply to the current version of this application. If future versions introduce data collection, a full privacy notice will be provided.

Third parties. No data is shared with third parties. The application loads fonts from Google Fonts (googleapis.com) on first load only.
I confirm that:
I am a qualified healthcare professional or a student under direct clinical supervision
I understand this tool does not replace clinical judgement and I remain fully responsible for all clinical decisions
I will verify all drug doses against my local formulary before prescribing
I have read and understood the Terms of Use and Data & Privacy sections above
By tapping Accept, you confirm all statements above and agree to these terms.
PE Manager v1.0 · Last reviewed May 2026 · For educational use only
ℹ️Clinical Decision Support Tool — 2026 AHA/ACC Acute PE Guidelines. Educational use only. Always apply clinical judgement.
Quick Actions
🔴 Patient Assessment
Haemodynamics → Wells/PERC → Imaging → sPESI → A–E Category → Management
Start Assessment →
📊 A–E Category Reference
Full 2026 AHA/ACC classification with management plans
View Categories →
⚖️ Dose Calculator
Enter patient weight → get all weight-based doses instantly
Open Calculator →
2026 Key Changes
  • A–E classification replaces massive/submassive/low-risk
  • R modifier for respiratory compromise on any category
  • PERT upgraded to Class I for Cat C3, D, E
  • DOACs preferred over warfarin; LMWH over UFH
  • Cat A (incidental) dischargeable from ED
FOR EDUCATIONAL USE ONLY · NOT A SUBSTITUTE FOR CLINICAL JUDGEMENT
① Haemo
② Wells/PERC
③ Imaging
④ sPESI
⑤ A–E Category
⑥ Management
Step 1 — Haemodynamic Status
⚡Check FIRST. Instability = Category D/E → immediate action. Do not delay for scoring.
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 tab to apply 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: Age × 10 µg/L
Sensitivity: 97%
NPV: ~99%
🔬 CTPA Result
Gold standard · 94% sensitivity · 98% specificity
☢️ V/Q SPECT Result
Use when CTPA contraindicated · 92% sensitivity · 91% specificity
← Back
Step 4 — sPESI Score (Post-diagnosis)
ℹ️Use after PE confirmed. sPESI feeds directly into A–E category.
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
Likely Category B
← Back
Step 5 — Assign A–E Category
📊3 questions → exact AHA/ACC category + full 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 for your patient.
A–E Category Reference
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/↑O₂ present. Does not change letter — forces higher monitoring and prevents early discharge.
Parenteral
DOACs
Thrombolytics
Special Pop.
✅LMWH preferred over UFH (Class I · 2026). UFH for: CrCl <30, pre-thrombolysis, instability.
Enoxaparin PREFERRED
LMWH · 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
Bolus
80 U/kg IVmax 10,000 U
Infusion
18 U/kg/hr
Target aPTT
60–80 sec
Fondaparinux
Selective anti-Xa · SC OD
<50 / 50–100 / >100 kg
5 / 7.5 / 10 mg
Biomarkers
Echo/CT
ECG
D-dimer
Standard cutoff
<0.5 mg/L
Age-adjusted (>50)
Age × 10 µg/L
Sensitivity / NPV
97% / ~99%
Troponin
Conventional TnI
>0.1 ng/mL = abnormal
hs-Tn safe threshold
<14 pg/mL = NPV 98%
BNP / NT-proBNP
BNP cutoff
>100 pg/mL
NT-proBNP cutoff
>600 pg/mL
Lactate
Elevated
>2 mmol/L
Shock / Cat D–E trigger
>4 mmol/L
Anticoagulation Reversal — Bleeding Management
🚨Major bleeding on anticoagulation is a medical emergency. Stop anticoagulant. Establish IV access. Call haematology. Assess for source of bleeding.
Reversal Agents
Approach
Restarting AC
Andexanet Alfa Anti-Xa reversal
Reverses: Rivaroxaban · Apixaban · Edoxaban
Rivaroxaban/Apixaban: Low dose
400 mg bolus + 480 mg/2h
Rivaroxaban/Apixaban: High dose
800 mg bolus + 960 mg/2h
Timing
Low if >8h since last dose
Idarucizumab (Praxbind) Dabigatran reversal
Reverses: Dabigatran only · Specific antidote
Dose
5 g IV (2 × 2.5 g)
Administration
Two 2.5 g vials IV over 5–10 min
Protamine Sulphate Heparin reversal
Reverses: UFH (full) · LMWH (partial ~60–80%)
UFH reversal
1 mg per 100 U UFH given in last 2h
Enoxaparin reversal
1 mg per 1 mg enoxaparin (if <8h since dose)
Maximum single dose
50 mg IV over 10 min
4-Factor PCC (Beriplex / Octaplex) Warfarin reversal
Reverses: Warfarin · Also used for DOAC life-threatening bleed if specific 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 haemostatic
Antifibrinolytic · Adjunct in major haemorrhage
Loading dose
1 g IV over 10 min
Maintenance
1 g IV over 8h
Post-PE Follow-Up & Long-Term Management
📅This section guides management after the acute phase is resolved and the patient is stable on anticoagulation.
Timeline
AC Duration
CTEPH Screen
Thrombophilia
Discharge
Anticoagulation started
Yes — confirm before discharge
Patient education
Signs of bleeding, PE recurrence, compliance
Written information
Anticoagulation booklet + emergency card
1–2 Weeks (Cat A/B) · 5–7 Days (Cat B)
Review
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 Basis
This application is based on:
[1]2026 AHA/ACC/ACCP/ACEP Clinical Practice Guideline for the Diagnosis and Management of Acute Pulmonary Embolism — First dedicated AHA/ACC guideline for PE
[2]2019 ESC Guidelines on Acute Pulmonary Embolism (Konstantinides SV et al., Eur Heart J 2020)
[3]AMPLIFY trial — Apixaban for VTE (Agnelli G et al., NEJM 2013)
[4]EINSTEIN-PE trial — Rivaroxaban for PE (EINSTEIN Investigators, NEJM 2012)
[5]Hokusai-VTE trial — Edoxaban for VTE (Büller HR et al., NEJM 2013)
[6]CLOT trial — Dalteparin in cancer VTE (Lee AY et al., NEJM 2003)
[7]TRAPS trial — Rivaroxaban vs Warfarin in APS (Pengo V et al., NEJM 2018)
[8]PIOPED II — CTPA diagnostic accuracy (Stein PD et al., NEJM 2006)
[9]Wells PE Score (Wells PS et al., Ann Intern Med 2001)
[10]PERC Rule (Kline JA et al., J Thromb Haemost 2004)
[11]sPESI (Jiménez D et al., Eur Respir J 2010)
[12]Hestia Criteria (Zondag W et al., J Thromb Haemost 2011)
⚠️ Limitations
  • This tool has not undergone formal clinical validation studies
  • Not approved as a regulated medical device (MHRA / FDA / CE)
  • Not validated for paediatric patients (under 18)
  • Dose calculations are guidance only — always verify locally
  • Guidelines evolve — check for app updates regularly
  • Local protocols may differ from 2026 AHA/ACC recommendations
📋 Legal & Compliance
📞 PERT / Emergency Contacts
Update these with your local team numbers
🚨
PERT On-Call
Tap to set your local PERT number
🔴
Haematology On-Call
Tap to set your local haematology number
💙
Cardiology / ECMO
Tap to set your local number
PE Manager v1.0 · Last updated 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