03-15-2008, 08:56 PM
A 62-year-old man is recovering from an aortic valve replacement for infective endocarditis complicated by perivalvular abscess. While in the hospital recovering from his operation, he suffers sudden shortness of breath, pleuritic chest pain, and tachycardia. An electrocardiogram reveals right ventricular strain and sinus tachycardia, but is otherwise unremarkable. A stat CT angiogram confirms the diagnosis of pulmonary embolus, revealing a right subsegmental blood clot. In addition to his recent valve replacement, the patient has a history of a recent hemorrhagic stroke believed related to a septic emboli, hypertension, and diabetes. Which of the following is the most appropriate management of the pulmonary embolus?
A. Inferior venal caval interruption
B. Low-molecular weight heparin
C. Thrombolytic therapy
D. Unfractionated heparin
E. Unfractionated heparin and warfarin
A. Inferior venal caval interruption
B. Low-molecular weight heparin
C. Thrombolytic therapy
D. Unfractionated heparin
E. Unfractionated heparin and warfarin