Pulmonary embolism: The Daily PANCE Blueprint

Home Pulmonary embolism: The Daily PANCE Blueprint

Pulmonary embolism: The Daily PANCE Blueprint

A 68-year-old woman with active cancer presents with acute onset dyspnea and pleuritic chest pain. Vital signs are normal. D-dimer is elevated. CT pulmonary angiography shows filling defects within segmental pulmonary arteries in the right lower lobe concerning for PE. Which of the following is the most appropriate next step in management?

A. Unfractionated heparin infusion
B. Low molecular weight heparin
C. Dabigatran
D. Inferior vena cava filter
E. Thrombolytic therapy

Answer and topic summary

The answer is B) Low molecular weight heparin

This cancer patient has imaging findings consistent with acute segmental pulmonary embolism. Initial anticoagulation is with either intravenous unfractionated heparin or low molecular weight heparin. In hemodynamically stable patients with malignancy and PE, LMW heparin and some of the direct oral anticoagulants, edoxaban, and apixaban, are used as anticoagulants. Direct oral thrombin inhibitors (Dabigatran) are generally not used in this population. IVC filters are reserved for patients with contraindications to anticoagulation. Thrombolysis is only used for massive, life-threatening PE.

View blueprint lesson

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Pulmonary Circulation ⇒ Pulmonary embolism (ReelDx)

Also covered in the Emergency Medicine and Internal Medicine EOR content blueprint

Sign up for the ENTIRE Blueprint Daily Email Series (500 days and counting! 😀)

Sign Up
X