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. Protocols and Guidelines have been improving results of our clinical practice. Sometimes there have been differences between guidelines on the same topic, but they have not been so important usually. As far as the start of vitamin K antagonist (VKA) in a non-high risk pulmonary thromboembolism (PTE) patient is concerned, there is global consensus (reflected in all comprehensive guidelines) that it should be on the admission day or a day later. However, there are situations in which this administering VKA from the first (or second) day of hospitalization may actually complicate the treatment. Case report. As an illustration, our female, 71 years old patient with second unprovoked, intermediate-high risk PTE was given low -molecular -weight -heparin (LMWH) + VKA from the second day. Due to lack of improvement in symptoms, oxygen saturation and D dimer after 9 days, Computerized tomography pulmonary angiography (CTPA) was repeated and it confirmed minimal advancement. She already had achieved target international normalized ratio (INR) and it complicated proceeding to fibrinolytic therapy. Conclusion. Therefore, correction of the therapeutic approach may be needed even if the treatment is completely according to the latest guidelines. We suggest postponing VKA from the first (or second) day of hospitalization (as suggested in all available guidelines for non-high risk PTE patients) until satisfying clinical improvement is reached.

Should anti-vitamin K be started on the first day in non-high risk pulmonary embolism?