A 25-year-old female presents with acute dyspnoea, pleuritic chest pain, and a swollen left leg. She takes the combined oral contraceptive pill and re...

Question

A 25-year-old female presents with acute dyspnoea, pleuritic chest pain, and a swollen left leg. She takes the combined oral contraceptive pill and recently had a 12-hour bus journey. Her Wells score for PE is 6 (high probability). She is haemodynamically stable. Per NICE NG158, what initial management should be started in the emergency department while awaiting CTPA?

Accepted Answer

Therapeutic anticoagulation with LMWH or DOAC - anticoagulation should be started immediately in patients with high clinical probability while awaiting imaging confirmation

Answer

Perform a D-dimer first - only start anticoagulation if positive

Answer

Withhold anticoagulation until CTPA confirms the diagnosis

Answer

Start IV heparin only - oral anticoagulants are contraindicated initially

Answer

Administer aspirin 300 mg as initial anticoagulant

uk-dipimc MCQ (SBA): High-Probability PE - Immediate Anticoagulation