Abstract: Patients with liver disease are more prone to thrombosis and bleeding events than healthy people. The decision to use anticoagulation in patients with pulmonary embolism and liver disease requires a cautious evaluation of the risks of bleeding and the benefits of anticoagulation. In this paper, we reported a case of a patient with fatty liver that developed pulmonary embolism. Although the low molecular weight heparin sodium injection was only administered at a regular dose, the patient still developed epistaxis and hematuria. After evaluating the efficacy and safety of different anticoagulants in patients with pulmonary embolism and liver dysfunction, rivaroxaban is more suitable for this patient to be treated by sequential therapy. After three weeks of treatment with rivaroxaban, the patient’s blood routine test results were normal, and no side effect was found. As far as we know, this is the first reported anticoagulant therapy case for patients with pulmonary embolism and fatty liver.