This handout is for pulmonary embolism (acute + extended). Your care team identified this based on: acute dyspnea, pleuritic chest pain, syncope, or hemoptysis (esc 2019 §5; aha/acc 2026).
Other reasons your team may use this plan: unexplained tachycardia + hypoxia (esc 2019 §5); elevated d-dimer with pe-compatible pretest probability (esc 2019 §6.3) — interpret conditional on wells band; echo or ct showing rv strain / dilation — risk not diagnosis (esc 2019 §7.3).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg PO BID × 7 d (loading) → 5 mg PO BID (maintenance) | PO | 10 mg BID × 7 d, then 5 mg BID | 2026 AHA/ACC Class 1 — DOAC over VKA. Therapeutic anticoagulation onset within hours of first oral dose (no parenteral lead-in). AMPLIFY (Agnelli NEJM 2013 PMID 23808982): recurrent VTE/VTE-death 2.3% vs 2.7%, RR 0.84 (95% CI 0.60–1.18, non-inferior p<0.001); major bleeding 0.6% vs 1.8%, RR 0.31 (95% CI 0.17–0.55, p<0.001 superiority) vs enoxaparin/warfarin. RxCUI 1364430 aligned to DrugEffectProfile registry. |
| rivaroxaban | 15 mg PO BID × 21 d (loading) → 20 mg PO daily with food (maintenance) | PO | BID × 21 d, then daily | Single-drug oral, no parenteral lead-in; peak anticoagulant effect 2–4 h. EINSTEIN-PE (NEJM 2012 PMID 22449293): recurrent VTE 2.1% vs 1.8%, HR 1.12 (95% CI 0.75–1.68, non-inferior); major bleeding 1.1% vs 2.2%, HR 0.49 (95% CI 0.31–0.79, p=0.003) vs enoxaparin/VKA. RxCUI 1114195 aligned to DrugEffectProfile registry. |
| edoxaban | 60 mg PO daily (30 mg if CrCl 15-50, weight ≤60 kg, or strong P-gp inhibitor) — after ≥5 d parenteral lead-in | PO | daily | Requires ≥5 d LMWH/UFH lead-in (anticoagulation from parenteral agent, edoxaban steady state ~3 d). Hokusai-VTE (Büller NEJM 2013 PMID 23991658): recurrent VTE 3.2% vs 3.5%, HR 0.89 (95% CI 0.70–1.13, non-inferior); clinically-relevant bleeding 8.5% vs 10.3%, HR 0.81 (95% CI 0.71–0.94, p=0.004) vs warfarin. RxCUI 1599538 aligned to DrugEffectProfile registry. |
| dabigatran | 150 mg PO BID after 5-10 d parenteral lead-in (110 mg if age ≥80 or high bleeding risk) | PO | BID | Requires 5–10 d parenteral lead-in (median 9 d in trial). RE-COVER (Schulman NEJM 2009 PMID 19966341): recurrent VTE 2.4% vs 2.1%, HR 1.10 (95% CI 0.65–1.84, non-inferior); major bleeding 1.6% vs 1.9%, HR 0.82 (95% CI 0.45–1.48); any bleeding HR 0.71 (95% CI 0.59–0.85) vs warfarin. Idarucizumab specific reversal. RxCUI 1037042 aligned to DrugEffectProfile registry. |
| warfarin | 5 mg PO daily, target INR 2-3, with LMWH/UFH bridge until INR ≥2 × 24 h | PO | daily, INR-driven | Reserve for DOAC contraindications; therapeutic INR takes ~5 d so requires LMWH/UFH bridge. Triple-positive APS: TRAPS 2-yr (Pengo JTH 2020 PMID 33128325) — DOAC-arm thromboembolic events 33.3% (2/6) vs warfarin 5.7% (6/109), HR 6.9 (95% CI 1.4–34.5, p=0.018) → warfarin INR 2-3 only. RxCUI 11289 aligned to DrugEffectProfile registry. |
Plan: 2026 AHA/ACC PE — anticoagulation + reperfusion ladder by Clinical Category A-E
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Reassess provoked vs unprovoked vs cancer; extended anticoagulation Class I for unprovoked (AHA/ACC 2026); reduced-dose DOAC (AMPLIFY-EXT Agnelli NEJM 2013 PMID 23216615; EINSTEIN-CHOICE); HERDOO2 (women) / DASH scores to guide stopping unprovoked; PEmb-QoL; occupational return
Guideline: 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Acute PE Guideline (Circulation 2026; PMID 41712677; DOI 10.1161/CIR.0000000000001415) + 2019 ESC Acute PE Guideline (PMID 31504429) + CHEST 2021 antithrombotic + ASH 2020 VTE