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A 63-year-old male with a history of type II diabetes, hypertension, and chronic kidney disease (CKD) stage IV presents to his primary care physician complaining of new onset swelling and calf tenderness in his right lower extremity. The patient has just returned from a trip to Europe for work. Examination of the extremity is shown in Figure A. The patient is referred to the Emergency Department, where he undergoes a right lower extremity duplex ultrasound shown in Figure B. Laboratory values are shown in Figure C. What is the next best step in management?
Treatment with unfractionated heparin
Initiate warfarin therapy
Aspirin and clopidogrel therapy
Treatment with low molecular weight heparin
Placement of an inferior vena cava filter
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A 46-year-old woman presents to the emergency department with 1 day of painful leg swelling. She is otherwise healthy and takes only oral contraceptive pills. The patient does not regularly follow up with her primary doctor and is generally not medically compliant. Her temperature is 98.0°F (36.7°C), blood pressure is 122/78 mm Hg, pulse is 70/min, respirations are 13/min, and oxygen saturation is 99% on room air. Lower extremity examination shows mild calf swelling on her left leg, but otherwise is unremarkable. An ultrasound is performed as seen in Figure A. Which of the following is the most appropriate course of action?
A 62-year-old Nigerian woman arrived 2 days ago to the US to visit her adult children from Nigeria. She is now brought to an urgent care center by her daughter for leg pain. Her right leg has been painful for 24 hours and is now causing her to limp. She denies any fevers, chills, or sweats and does not remember injuring her leg. She tells you she takes medications for hypertension and diabetes and occasionally for exertional chest pain. She has not had any recent chest pain. The right leg is swollen and tender. Flexion of the right ankle causes a worsening of the pain. Doppler ultrasonography reveals a large clot in a deep vein. Which of the following is the most appropriate course of action?
Serologic tests for hypercoagulability
Initiation of warfarin
Initiation of heparin
Treatment with tissue plasminogen activator
Initiation of heparin followed by bridge to warfarin