Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment for pulmonary embolism?

1. Warfarin

2. LMWH (Low Molecular Weight Heparin)

3. Rivaroxaban

4. Fondaparinux

The correct answer is: LMWH (Low Molecular Weight Heparin)

The first-line treatment for pulmonary embolism is Low Molecular Weight Heparin (LMWH). LMWH is preferred because it provides rapid anticoagulation for patients with acute pulmonary embolism. It works by inhibiting the factor Xa and, to a lesser extent, thrombin, which is crucial in the clotting process. LMWH can be administered via subcutaneous injection, which allows for outpatient management in many patients without the need for continuous monitoring of anticoagulation levels, unlike unfractionated heparin. In acute settings, administering LMWH helps to prevent further clot formation while enabling the body's natural mechanisms to gradually dissolve the existing clots. Other anticoagulants, such as warfarin, rivaroxaban, and fondaparinux, also play roles in the management of pulmonary embolism. However, they are not considered first-line treatment in the acute phase. Warfarin is typically used for long-term management and requires monitoring. Rivaroxaban and fondaparinux may be alternatives in certain situations, but LMWH remains the gold standard in acute treatment due to its efficacy and ease of use.