What are the options for anticoagulation for a patient presenting with pulmonary embolism?

Acute Management

Parenteral, weight-adjusted anticoagulation should be used:

Low-molecular weight heparin (LMWH) SC
Fondaparinux SC
Unfractionated heparin (UFH) IV
- Generally second line due to higher bleeding risk and HIT risk
- Preferred agent in the setting of:
  - Overt haemodynamic instability or imminent haemodynamic decompensation in whom primary reperfusion treatment will be necessary (short half life and easy reversal)
  - Increased risk of bleeding
  - Serious renal impairment (creatinine clearance <30 mL/min)

Longer-Term Management

Started when the patient's condition is stable and no invasive procedures are planned

Non-vitamin K oral anticoagulant (NOAC)
Warfarin international normalized ratio (INR) is 2.0 to 3.0:

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