Intravenous unfractionated heparin is the preferred treatment in massive PE with cardiovascular compromise.
The leg should be elevated, TED stocking applied to reduce oedema and mobilisation should be encouraged.
Routine measurement of peak anti-Xa activity for patients on
LMWH is not recommended except in women at extremes of body weight (<
50 kg and > 90 kg) or with other complicating factors (for example
with renal impairment or recurrent VTE) putting them at high risk.
Peak
anti-Xa (3 hours post-injection) should be 0.5–1.2 units/ml.
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