A 74-year-old woman with metastatic breast cancer presents with sudden dyspnoea and pleuritic chest pain. CT pulmonary angiography confirms bilateral pulmonary emboli, and echocardiography shows right-ventricular strain; her blood pressure is 82/48 mmHg despite an initial fluid bolus. She has no active intracranial bleeding or recent major surgery. Which treatment should be arranged urgently?
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