A 32-Year-Old Man Comes to the Emergency Department Due to a Day

question 709

Multiple Choice

A 32-year-old man comes to the emergency department due to a day of worsening pain and swelling in his right leg.  He has no fever, chest pain, or shortness of breath.  The patient was hospitalized 2 weeks ago for right lower extremity deep vein thrombosis after a minor sports injury; he was discharged on warfarin.  When he left the hospital, his INR was 2.2 (goal:  2-3) .  The patient has been taking warfarin daily; however, due to a busy work schedule, his dietary intake has been variable and last week he missed his clinic appointment for anticoagulation monitoring.  He has no other medical problems.  Blood pressure is 120/70 mm Hg, pulse is 70/min, and respirations are 14/min.  Examination shows moderate pretibial edema in the right leg.  Today, his INR is 1.3.  Platelet count, creatinine, and liver function tests are within normal limits.  Venous Doppler ultrasound shows a right popliteal vein thrombus that extends into the femoral vein and is worse than on previous ultrasound.  What is the best next step in management of this patient?

• A)Increase warfarin dose and follow up in 3 days
• B)Initiate thrombolytic therapy
• C)Place inferior vena cava filter
• D)Replace warfarin with rivaroxaban
• E)Start low-dose aspirin

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Definitions:

Physician's Office Laboratory

A small lab located within a physician's office where various tests are performed on-site to aid in the quick diagnosis and treatment of patients.

Turnaround Time

The amount of time taken to complete a process, task, or fulfill an order from start to finish.

Technological Resources

Assets in the form of technology, such as software and hardware, that assist in the operations and management of an organization.

Moderate-complexity Tests

Laboratory tests that require a moderate level of expertise, equipment, and interpretative judgment.