›Time critical pathway
›If PE alarm features, resuscitation pathway
›If threatened limb concern, vascular surgery emergent
›If hemodynamically stable, proceed with pretest probability based testing
›Testing sequence
›Low pretest probability plus D dimer first local protocol dependent
›Moderate or high pretest probability ultrasound first
›If ultrasound negative and high suspicion, repeat ultrasound 5 to 7 days or advanced imaging
Anticoagulation initiation
›If confirmed DVT
›Anticoagulation initiation unless contraindicated
›DOAC option local protocol dependent
›Apixaban
›10 mg PO twice daily for 7 days
›Then 5 mg PO twice daily
›Rivaroxaban
›15 mg PO twice daily for 21 days
›Then 20 mg PO daily
›LMWH option
›Enoxaparin 1 mg per kg SC every 12 hours
›Renal adjustment prompt if eGFR under 30
›Warfarin bridge option local protocol dependent
›Parenteral anticoagulation overlap until INR therapeutic
›INR monitoring required
Special population anticoagulation
›Pregnancy and postpartum
›LMWH preferred
›DOAC avoidance in pregnancy
›Breastfeeding compatibility review local protocol dependent
›Active cancer
›DOAC versus LMWH selection individualized
›Drug interaction review with oncology regimen
›Antiphospholipid syndrome concern
›DOAC avoidance consideration
›Hematology input
›Analgesia plan
›Acetaminophen dosing per local protocol
›NSAID caution with anticoagulation
›Limb care
›Ambulation guidance individualized
›Compression therapy timing discussion after acute phase local protocol dependent
›Consult triggers
›Vascular surgery for threatened limb or phlegmasia
›Hematology for recurrent unprovoked VTE or thrombophilia concern
›Obstetrics for pregnancy associated VTE
›Reassessment timing
›Repeat vitals after initial workup
›New dyspnea or chest pain triggers PE evaluation
›Worsening pain or swelling triggers compartment syndrome or phlegmasia reassessment