A 59-year-old woman presents to the emergency department with sudden-onset pleuritic chest pain and shortness of breath that began 2 hours ago. She underwent knee replacement surgery 10 days ago and reports worsening right calf pain over the past 3 days. She denies cough or fever. Vitals: BP 102/64 mmHg, HR 124/min, RR 30/min, O2 saturation 88% on room air, temperature 36.9°C. Examination: tachycardia, clear lungs, tender right calf with mild swelling, no jugular venous distension, no wheezing. Labs: D-dimer markedly elevated, troponin borderline elevated, ECG shows sinus tachycardia with an S1Q3T3 pattern. Chest X-ray: normal. CT pulmonary angiogram: large embolus in the right main pulmonary artery.
Question 1 of 29
Which one of the following is the most appropriate immediate management step?
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