What is the recommended initial management for suspected pulmonary embolism?

• A. Aspirin
• B. Compression stockings only
• C. Immediate anticoagulation with LMWH or heparin, then transition to warfarin or NOAC
• D. Thrombolysis for all

Answer: (C)

Starting anticoagulation right away is essential in suspected pulmonary embolism to prevent clot growth and new clot formation. Parenteral anticoagulation with low-molecular-weight heparin or unfractionated heparin is started promptly, even before imaging if clinical suspicion is high and there are no contraindications. After diagnosis or as you transition to longer-term therapy, switch to an oral anticoagulant such as warfarin or a direct oral anticoagulant. Aspirin does not adequately treat venous thromboembolism, and compression stockings help with symptoms but do not address the clot. Thrombolysis is reserved for massive PE with hemodynamic instability, given its bleeding risks and the fact that it is not appropriate for all suspected cases.