Pre-Quiz: Acute Management of DVT

A 64-year-old female, diagnosed with breast cancer 4 months ago, presents to the Emergency Department complaining of a swollen right lower limb, tenderness, and itching for the past 3 days. On examination, the entire right leg presents pitting edema and visible superficial veins with tenderness along the routes of the deep veins. The patient has no previous history of Deep Vein Thrombosis (DVT) nor recent surgeries.

According to the Wells’ score criteria, what is the predicted probability of this patient having a DVT?

A 42-year-old male, previously diagnosed with pancreatic cancer five months ago, now presents to the Emergency Department with a complaint of sudden swelling in the left lower limb over the past 4 days. This symptom is accompanied by noticeable pain. Clinical examination reveals pitting edema on the left leg, extending up to the knee. Superficial veins are visibly distended without any deep vein tenderness. There is a known history of Deep Vein Thrombosis (DVT) occurring three years ago as a result of a prolonged immobilization due to a long-bone fracture. Anticoagulant treatment with fondaparinux is initiated.

Given the patient’s weight is 52 kg, what would be the recommended dose of fondaparinux administered?

MB is a 40-year-old male with a significant medical history of colon cancer on chemotherapy, coexisting conditions including COPD, GERD, diabetes, and hypertension. He presents to the emergency room with a sudden bout of shortness of breath that began about 24 hours ago and worsening left calf pain for the past 3 days. The patient is currently on Pantoprazole (40 mg/daily), Metformin (500 mg/bid), Oxycodone ER (30 mg/bid), Lisinopril (20 mg/daily) and Hydromorphone (4 mg oral every 8 hrs PRN for breakthrough pain).

On examination, his left calf is red, pitting edema, warm and tender to touch. Vitals recorded were BP: 150/80 mm Hg, Respiratory Rate: 25/min, Heart Rate: 130 bpm, Temp: 97.5 F, and O2 Saturation: 92% on room air. A Complete Blood Count along with Chem 7 was taken and a D-Dimer level of >3,500 ng/mL was noted.

Given MB’s presenting symptoms, medical history, physical exam findings, vitals, and lab reports, which of the following diagnoses is most likely?

A 45-year-old woman presents to the emergency department with pain and swelling in her left leg. She has been on a long-haul flight and has been largely immobile. As a clinical pharmacist, you are asked to explain the pathophysiology of deep vein thrombosis (DVT) that might be occurring in this patient. Which of the following best describes the pathophysiology of DVT?

A 65-year-old woman presents to the emergency department with pain and swelling in her left leg. She has a history of breast cancer and recently underwent a mastectomy. She has been largely immobile post-surgery. As a clinical pharmacist, you are asked to identify the risk factors for deep vein thrombosis (DVT) in this patient. Which of the following are risk factors for DVT in this patient?