Which anticoagulant therapy is recommended for PE in all patients?

• A. Warfarin
• B. IV Heparin gtt
• C. Low molecular weight heparin injection
• D. Direct oral anticoagulants

Answer: (B)

The key idea is to start anticoagulation immediately with an agent that acts right away, can be adjusted as the patient’s status evolves, and can be stopped quickly if bleeding occurs. Unfractionated heparin given as a continuous IV infusion fits this well. It begins to anticoagulate within minutes, its dose can be titrated to a target laboratory goal (like an aPTT), and if there is bleeding or if urgent surgery is needed, the infusion can be stopped and its effects reversed with protamine. It also doesn’t rely on renal clearance, so it’s usable in patients with varying kidney function, which makes it suitable for a broad range of PE patients. As the patient stabilizes, this IV heparin can be followed by longer-term options such as a direct oral anticoagulant or warfarin, providing a smooth transition while ensuring reliable initial control. While other anticoagulants are common later in treatment, the IV heparin drip is the most universally applicable initial choice for acute PE.