A 34-year-old woman develops sudden right-sided pleuritic chest pain and mild breathlessness two days after a long flight. Heart rate 88/min, BP 118/76 mmHg, SpO2 95% on room air. CT pulmonary angiogram confirms a segmental pulmonary embolus. Troponin I is undetectable, echocardiography shows normal right ventricular function, and her simplified PESI score is 0. She has no contraindications to anticoagulation. The most appropriate management is:

• A Systemic thrombolysis with alteplase followed by heparin infusion
• B Admit to ICU for catheter-directed embolectomy
• C Aspirin 150 mg daily with follow-up in one week
• D Anticoagulation alone, with consideration of outpatient treatment given her low sPESI score and stable status ✓

Explanation

A sPESI score of 0 identifies low-risk pulmonary embolism. With normal troponin and right ventricular function she has no intermediate or high-risk features, so anticoagulation alone is sufficient; validated criteria allow selected low-risk patients to be treated as outpatients or discharged early. Thrombolysis is reserved for hemodynamically unstable massive PE or deteriorating submassive PE, and carries a major bleeding risk unjustified here. Aspirin is inadequate protection against recurrent venous thromboembolism.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.