<prompt> 47-year-old female with a history of Antiphospholipid antibody syndrome who has been non compliant with warfarin presents with deep vein thrombosis and dyspnea. She is hypotensive and tachypneic.CT of chest shows a saddle embolus. She does not respond to heparin and fluids. Echocardiogram shows RV hypokinesis. Which of the following is appropriate management?Urgent referral for surgical embolectomyRecombinant tissue plasminogen activatorContinue administration of fluids and heparinAdd lepirudin  <response>: Clinical scenario mentioned here points towards Massive pulmonary embolism. Option A: Referral for surgical embolectomy only to be done in case there is CI for thrombolysis Option B: This lady specially who is in hypercoagulable state, one has to do thrombolysis with recombinant tissue plasminogen activator rTPA Option C: Fluids will not be given because in question already mentioned that R.V. Hypokinesia fluid will fuher deteriorate condition. Option D: Lepirudin is used in Heparin induced Thrombocytopenia. 