Anticoagulation Dilemma in a Patient With Pulmonary Embolism and Massive Haemoptysis

The development of worsening haemoptysis in a patient with pulmonary embolism presents a significant treatment challenge, especially in a low-resource setting where advanced interventions such as bronchial artery embolization may not be readily available. We present the case of a 40-year-old morbidly obese woman who was transferred to our facility with recurrent lower-limb deep vein thrombosis and a new diagnosis of bilateral pulmonary embolism. Following initiation of oral anticoagulation with apixaban, she developed worsening haemoptysis that persisted despite dose adjustments. She was subsequently stabilized and discharged on a vitamin K antagonist (warfarin). This case highlights the clinical challenges encountered in managing anticoagulation in the setting of significant bleeding and underscores the importance of individualized anticoagulation therapies.