For a patient with a massive pulmonary embolism and hemodynamic instability, what is the most appropriate treatment option?

In the scenario of a patient presenting with a massive pulmonary embolism (PE) and concurrent hemodynamic instability, the primary goal is to quickly restore perfusion and improve hemodynamics. Intravenous tissue plasminogen activator (t-PA) is a thrombolytic agent that acts quickly to dissolve the clot causing the obstruction in the pulmonary artery, thus alleviating the severe symptoms associated with massive PE.

Administering t-PA is crucial because it can lead to rapid improvement in hemodynamic status in patients who are critically ill due to a massive embolism. The standard dosing regimen, which is typically 100 mg administered over 2 hours, has demonstrated efficacy in rapidly resolving the obstruction in such situations.

In contrast, options such as dabigatran, enoxaparin, and rivaroxaban are anticoagulants that are beneficial for the management of venous thromboembolism but are not adequate as first-line treatment for immediate hemodynamic instability caused by a massive PE. These agents help prevent further clot formation but do not provide the immediate thrombolytic activity required in acute settings like this scenario. Therefore, while they may play a role in the long-term management of PE, they do not address