AI-HEART Lab Clinical Tools
2026 AHA/ACC PE Guideline Calculator
Guideline-informed decision-support across 9 integrated modules. A-E Clinical Category system, pre-test probability scoring, severity stratification, anticoagulation selection, and PERT activation criteria.
How It Works HIPAA Compliant
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AI identifies vitals, biomarkers, imaging findings, and risk factors automatically
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One-click structured “# Pulmonary Embolism” note with guideline references
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Paste a previous visit note. Extracts: age, sex, medical history, comorbidities, prior DVT/PE, malignancy.
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A-E Clinical Category System: Replacing Massive/Submassive Terminology
The 2026 guideline retires the massive/submassive/low-risk classification and introduces a five-tier A-E system with subcategories and an R modifier for respiratory compromise. Category E2 (cardiac arrest) through Category A (incidental PE) provides more granular risk stratification to guide therapy selection.
Based on the 2026 AHA/ACC/ACCP/ACEP/CHEST Guideline, Figure 2 and Section 3.2.
Explore category assignment →What Has Changed Since the Guidelines Were Published
- HOME-PE confirmed outpatient feasibility: Simplified PESI score 0 plus Hestia negativity identifies patients safe for home discharge with event rates under 1.5%
- PEITHO-2 supports reduced-dose alteplase: Half-dose thrombolysis (50 mg alteplase) achieves comparable hemodynamic outcomes with lower bleeding risk in intermediate-high-risk PE
- CARAVAGGIO and SELECT-D established DOACs (apixaban, rivaroxaban) as effective alternatives to LMWH in cancer-associated VTE outside high-risk GI/GU tumors
- FLASH registry and OPTALYSE PE demonstrate catheter-directed thrombolysis with lower tPA doses and improved safety profiles for Category C3 and D patients
- CTEPH screening now formally recommended at 3-6 months post-PE with echocardiography per the 2026 guideline
Stay Current on PE Evidence
— landmark trials and new findings, with AI-contextualized summaries
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IMPORTANT: This software is clinical decision support (CDS) intended for use by licensed healthcare professionals under Section 520(o)(1)(E) of the Federal Food, Drug, and Cosmetic Act. It is not intended as a medical device. All recommendations are derived from the 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism (Circulation 2026;153:e977-e1051) and must be independently verified by the treating clinician before any clinical action. AI-generated content (including extracted data and clinical notes) is produced by large language models and may contain errors, omissions, or hallucinations — clinician review is mandatory. Patient data entered into the calculator is processed entirely in the browser; AI features process data server-side under a signed HIPAA Business Associate Agreement with no data retention. AI-HEART Lab, its affiliates, and contributors assume no liability for clinical decisions made using this tool. By using this tool, you acknowledge these limitations and accept full responsibility for clinical decisions.
Calculator computation is 100% client-side. Opt-in AI features process data server-side under a signed HIPAA BAA with no data retention.
About This Tool
This calculator implements the A-E Clinical Category system introduced by the 2026 AHA/ACC/ACCP/ACEP/CHEST Guideline for the Evaluation and Management of Acute Pulmonary Embolism (Circulation 2026;153:e977–e1051). The new classification retires the massive/submassive/low-risk terminology used since 2011 in favor of a more granular five-tier system with subcategories and an R modifier for respiratory compromise.
The tool provides guideline-informed decision support across 9 interactive modules: pre-test probability scoring (Wells, Revised Geneva, PERC, YEARS), D-dimer interpretation with age-adjusted and YEARS-adjusted thresholds, severity assessment (PESI, sPESI, Bova score), PE category assignment (A through E2 with R modifier), outpatient eligibility via Hestia criteria, anticoagulation selection with dosing, treatment duration, advanced therapies (PERT criteria, thrombolysis, thrombectomy, catheter-directed therapy), and special populations (pregnancy, cancer-associated VTE, CKD, obesity).
Calculator computation occurs entirely in your browser. Opt-in AI features (data extraction, note generation, email delivery) process clinical data server-side under a signed HIPAA Business Associate Agreement — data is held in memory only and never persisted or logged.
What Changed in the 2026 PE Guidelines
The 2026 AHA/ACC/ACCP/ACEP/CHEST Guideline for the Evaluation and Management of Acute Pulmonary Embolism represents the first comprehensive U.S. guideline update since the 2019 ESC document. It introduces structural and therapeutic changes that affect how PE is classified, risk-stratified, and treated across all care settings.
New A-E Clinical Category System
The most significant structural change is the retirement of the massive/submassive/ low-risk classification. The new A-E Clinical Category system provides more granular stratification. Category A covers incidentally discovered PE. Category B (B1 subsegmental, B2 segmental or higher) covers symptomatic PE without hemodynamic compromise or elevated biomarkers. Category C (C1 through C3) covers symptomatic PE with escalating biomarker elevation and RV dysfunction. Category D covers transient hemodynamic compromise. Category E (E1 sustained compromise, E2 cardiac arrest) covers the highest-risk presentations requiring immediate advanced therapy.
R Modifier for Respiratory Compromise
A new R modifier can be appended to any category (e.g., Category C2-R) when the patient has respiratory compromise defined as SpO2 below 90%, PaO2 below 60 mmHg, or requirement for supplemental oxygen to maintain SpO2 at or above 90%. The R modifier signals higher urgency and may influence decisions around advanced therapies.
PERT Activation Criteria Formalized
The 2026 guideline formally endorses Pulmonary Embolism Response Team (PERT) activation for Category C3, D, and E patients. PERT facilitates multidisciplinary decision-making involving cardiology, cardiac surgery, interventional radiology, pulmonology, and emergency medicine to select optimal reperfusion strategies. This is the first guideline to specify PERT activation criteria rather than treating PERT as an institutional option.
DOACs as First-Line (COR 1, LOE A)
Direct oral anticoagulants receive the highest recommendation class (COR 1, LOE A) as first-line therapy for most PE patients who are not pregnant and do not have severe renal impairment. Rivaroxaban and apixaban can be started immediately without parenteral bridging. Edoxaban and dabigatran require 5-10 days of initial parenteral therapy. Anticoagulation selection in cancer-associated VTE has also been updated, with DOACs preferred over LMWH except in high-risk GI or GU malignancies.
Age-Adjusted D-Dimer Endorsed (COR 2a)
Age-adjusted D-dimer (age × 10 μg/L for patients over 50 years) receives a Class 2a recommendation for the first time in a U.S. PE guideline. The YEARS algorithm, which uses a threshold of 1,000 μg/L in patients with zero YEARS criteria, is also endorsed. Both strategies reduce unnecessary CT pulmonary angiography while maintaining high sensitivity for PE. D-dimer interpretation in this calculator incorporates all three thresholds based on patient age and YEARS criteria.
Hestia Criteria for Outpatient Management (COR 2a)
The Hestia criteria (11 exclusion items) receive a Class 2a recommendation for identifying patients suitable for outpatient PE management. Combined with sPESI score of 0 or PESI class I-II, Hestia negativity identifies patients with 30-day event rates below 1.5% who can be safely discharged from the emergency department.
CTEPH Screening Recommendation
The 2026 guideline includes a formal recommendation for chronic thromboembolic pulmonary hypertension (CTEPH) screening with echocardiography at 3-6 months following acute PE, particularly for patients with persistent symptoms, elevated NT-proBNP, or risk factors for CTEPH development. Early CTEPH identification enables referral for pulmonary endarterectomy or balloon pulmonary angioplasty before irreversible pulmonary vascular remodeling occurs.
Frequently Asked Questions
What is the A-E Clinical Category system for pulmonary embolism?
The 2026 AHA/ACC PE Guideline introduces an A-E Clinical Category system that replaces the older massive/submassive/low-risk terminology. Category A covers incidental PE. Category B (B1: subsegmental, B2: segmental or higher) covers symptomatic PE without hemodynamic compromise or elevated biomarkers. Category C (C1 through C3) covers symptomatic PE with escalating biomarker elevation and RV dysfunction. Category D covers transient hemodynamic compromise. Category E (E1: sustained compromise, E2: cardiac arrest) covers the highest-risk presentations. An R modifier is appended when respiratory compromise is present.
When should the PERC rule be applied?
The PERC rule applies only in patients with low pre-test probability. All 8 criteria must be negative to rule out PE without D-dimer: age under 50, heart rate below 100, SpO2 at least 95% on room air, no hemoptysis, no estrogen use, no prior DVT or PE, no unilateral leg swelling, and no recent surgery or trauma requiring hospitalization. If any criterion is positive, proceed to D-dimer testing.
What is the age-adjusted D-dimer threshold?
For patients over 50 years old, the threshold is age × 10 μg/L FEU instead of the standard 500 μg/L. A 70-year-old therefore has a threshold of 700 μg/L. The YEARS algorithm uses 1,000 μg/L in patients with zero YEARS criteria, regardless of age. Both strategies are endorsed as Class 2a recommendations in the 2026 guideline.
Which anticoagulant should be used first for most PE patients?
DOACs are recommended as first-line therapy (COR 1, LOE A) for most PE patients without pregnancy or severe renal impairment. Rivaroxaban (15 mg twice daily for 21 days then 20 mg daily) and apixaban (10 mg twice daily for 7 days then 5 mg twice daily) can be started immediately. Edoxaban and dabigatran require 5-10 days of initial parenteral therapy. LMWH remains preferred in pregnancy and most cancer-associated VTE.
What are the Hestia criteria for outpatient PE management?
Hestia consists of 11 exclusion questions. Outpatient treatment is contraindicated if any criterion is positive: hemodynamic instability (SBP <100 and HR >100), need for thrombolysis or embolectomy, active bleeding or high bleeding risk, O2 requirement >24 hours, PE on therapeutic anticoagulation, severe pain requiring IV opioids >24 hours, medical or social reason requiring admission >24 hours, CrCl <30 mL/min, severe liver impairment, pregnancy, or history of HIT.
When should a PERT be activated?
The 2026 guideline endorses PERT activation for Category C3 (biomarkers plus RV dysfunction), Category D (transient hemodynamic compromise), and Category E (sustained compromise or cardiac arrest). PERT should also be activated when advanced therapies — systemic thrombolysis, catheter-directed therapy, or surgical embolectomy — are under consideration, or when clinical uncertainty exists about optimal management.
How long should anticoagulation continue after PE?
Duration depends on provoked versus unprovoked status. Provoked PE with a major reversible trigger (surgery, major trauma, or prolonged immobilization) requires 3 months. Unprovoked PE requires at least 3 months with reassessment for extended therapy; indefinite anticoagulation is recommended if bleeding risk is low to moderate. Cancer-associated PE requires extended therapy as long as cancer is active. Antiphospholipid syndrome requires indefinite anticoagulation.
Does this calculator store or transmit patient data?
Calculator computation occurs entirely in your browser with no server transmission. Opt-in AI features (data extraction, AI-generated notes, email delivery) process clinical data server-side under a signed HIPAA Business Associate Agreement — data is held in memory only during the request and is never persisted, cached, or logged.
Reference
Stevens SM, Woller SC, Kreuziger LB, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/ SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism. Circulation. 2026;153:e977–e1051. doi:10.1161/CIR.0000000000001281
Developed by AI-HEART Lab
Built by Dr. Rahul Chaudhary, a physician-scientist with 150+ publications and 18 international guideline citations, trained at Johns Hopkins University and UPMC, former faculty at Mayo Clinic Rochester.