47-year-old female with a history of Antiphospholipid antibody syndrome who has been non compliant with warfarin presents with deep vein thrombosis and dyspnea. She is hypotensive and tachypneic.CT of chest shows a saddle embolus. She does not respond to heparin and fluids. Echocardiogram shows RV hypokinesis. Which of the following is appropriate management?
Correct Answer: Recombinant tissue plasminogen activator
Description: Clinical scenario mentioned here points towards Massive pulmonary embolism. Option A: Referral for surgical embolectomy only to be done in case there is C/I for thrombolysis (Option B): This lady specially who is in hypercoagulable state, one has to do thrombolysis with recombinant tissue plasminogen activator (rTPA) Option C: Fluids will not be given because in question already mentioned that R.V. Hypokinesia & fluid will fuher deteriorate condition. Option D: Lepirudin is used in Heparin induced Thrombocytopenia.
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