Clinical Case Scenario
A 68-year-old male presents to the ED with acute onset of severe dyspnoea, pleuritic chest pain, and lightheadedness. He has a history of recent prolonged immobility.
Upon arrival, he is hypotensive (BP, 70/40 mmHg), tachycardic (HR, 130 bpm), tachypneic (RR, 38 bpm), and profoundly hypoxemic (SpO2, 78% on room air), requiring immediate tracheal intubation. Physical exam reveals a swollen, tender right lower extremity.
Initial labs show a significantly elevated D-dimer and a platelet count of 65,000/µL. A lower limb Doppler reveals a deep venous thrombosis (DVT) in the bilateral proximal femoral veins. An immediate CT pulmonary angiogram (CTPA) reveals a large saddle pulmonary embolus (PE) with significant right ventricular strain.
Which of the following is the most appropriate management option at this time point?
