Direct oral anticoagulants (DOACs) represent an important advance in the treatment of pulmonary thromboembolism, and their effectiveness is supported by the results of phase III clinical trials and their inclusion in international treatment guidelines. Although DOACs offer the advantage of a fixed dose and easier administration, in clinical practice they are often used generically without considering individual patient factors such as comorbidities, physiological parameters, and specific clinical circumstances. The article analyzes the factors that support the widespread use of DOACs, while identifying patient-specific risk profiles. The author proposes the creation of a system of dynamic risk stratification, which should lead to personalized treatment adapted to the needs of each patient. A future goal is to develop and validate integrated stratification tools that combine clinical patient characteristics, biomarker trends, and patient preferences. Such approaches are necessary to achieve truly individualized anticoagulation therapy that maximizes the safety and efficacy of pulmonary thromboembolism treatment for each individual patient.