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?

Clinical scenario mentioned here points towards Massive pulmonary embolism. Option A: Referral for surgical embolectomy only to be done in case there is C/I 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.