A 39-year-old woman presents to the emergency department on day 3 of her menstrual period, soaking a pad every hour for the past 6 hours and passing small clots. Three weeks ago she was diagnosed with an unprovoked pulmonary embolism and started rivaroxaban 15 mg PO BID, and she is due to change to 20 mg PO once daily this week. Before this, her cycles were regular every 28 days with 5 days of moderate flow, and she takes no hormonal medications. She feels lightheaded on standing but is not syncopal. Pelvic examination is normal apart from menstrual blood in the vagina, and a urine pregnancy test is negative. Hemoglobin is 98 g/L (115-155), compared with 128 g/L three weeks ago, platelets 265 x10^9/L (150-400), and ferritin 9 µg/L (15-200).
| Heart rate | 96/min |
| Respiratory rate | 16/min |
| Temperature | 36.9 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 118/72 mm Hg |
Question 1 of 36
Which of the following are the most appropriate initial management options?
Select 2. (0 / 2 selected)
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