1.The new 2026 PE framework provides a basis for identifying patients who can safely go home. Categories A (incidental), B (low clinical severity, subsegmental) are candidates for early discharge. Categories C (elevated risk severity), D (incipient cardiopulmonary failure) and E (cardiopulmonary failure) require inpatient care.

2. LMWH is now preferred over UFH for initial parenteral anticoagulation. This shifts the practice away from the default UFH infusion for most admitted PE patients.

3. Direct oral anticoagulants carry a strong recommendation over vitamin K antagonists for eligible patients, both to prevent recurrent VTE and to reduce major bleeding risk. Initiating a DOAC from the ED is now well-supported.

4. Patients with elevated biomarkers, right ventricular dysfunction/dilation, respiratory distress and incipient cardiopulmonary failure should be hospitalized. Advanced therapies, including systemic thrombolysis, catheter directed thrombolysis, mechanical thrombectomy, and surgical embolectomy are reasonable for patients with acute PE Category E and can be considered for patients with Category D.

5. In patients with a first acute PE without a major reversible risk factor, continuing anticoagulation beyond the initial treatment phase (3-6 months) is recommended. Patients who have had  PE should be asked about PE-related symptoms and functional limitations to screen for chronic thromboembolic pulmonary hypertension and other causes of dyspnea.