This patient can receive anticoagulant therapy in the outpatient setting. When treating acute pulmonary embolism (PE), it is essential to initiate anticoagulation immediately and achieve therapeutic levels of anticoagulation within 24 hours; failure to do so correlates with an increased risk of clinical progression and recurrence. Anticoagulation can be achieved with unfractionated heparin (either intravenous or subcutaneous), subcutaneous low-molecular-weight heparin (LMWH), or the pentasaccharide fondaparinux. Outpatient management is safe for up to 50% of patients with PE, including some with mild right heart strain on cardiac echocardiography. However, hospital admission is appropriate for patients who are too ill to be managed at home (those needing supplemental oxygen or requiring intravenous pain medications) and those with comorbid conditions that may contribute to rapid clinical deterioration (for example, high bleeding risk).

A 2012 guideline from the American College of Chest Physicians (ACCP) recommends thrombolytic therapy for patients with PE and a systolic blood pressure less than 90 mm Hg and without contraindications (for example, high bleeding risk). Thrombolytic therapy does not appear to have therapeutic benefit in unselected patients with acute PE and is associated with an increased risk for major hemorrhage. No clear evidence indicates thrombolytic therapy should be used in patients with evidence of pulmonary hypertension or right ventricular dysfunction detected by echocardiography, positive cardiac enzymes, or both. This patient has no indications for thrombolytic therapy. If thrombolytic therapy were appropriate, the ACCP's guidelines recommend systemic administration rather than catheter-directed thrombolysis.