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Pulmonary Embolism — RACP Adult Medicine MCQ

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HardRespiratoryPulmonary EmbolismRACP Adult Medicine

A 30-year-old with acute pulmonary embolism has persistent systolic blood pressure of 78 mmHg, cool peripheries, confusion and right-ventricular dilatation. There is no major bleeding contraindication. What is the preferred reperfusion strategy?

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Correct answer: D — Give immediate systemic thrombolysis while providing anticoagulation and organ support

The best answer is “Give immediate systemic thrombolysis while providing anticoagulation and organ support”. Persistent hypotension with hypoperfusion defines high-risk pulmonary embolism. In the absence of a prohibitive bleeding risk, systemic thrombolysis is the usual immediate reperfusion treatment; catheter or surgical options are considered when thrombolysis is contraindicated or unsuccessful. Oral anticoagulation alone is too slow for shock, and a filter neither lyses the embolus nor replaces anticoagulation.

Reference: Medical Journal of Australia: Australasian venous thromboembolism guideline: https://www.mja.com.au/journal/2019/new-guidelines-venous-thromboembolism