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Alteplase
0%
0/8
Heparin
62%
5/8
Observation
Rivaroxaban
25%
2/8
Warfarin
12%
1/8
Select Answer to see Preferred Response
This patient presents with leg swelling and is found to have an uncomplicated deep venous thrombosis (DVT) on ultrasound without any other complications or concerning medical history. In otherwise healthy patients, oral anticoagulants such as rivaroxaban are appropriate for a DVT and are particularly useful in patients who desire simple dosing/treatment. A DVT can present with minor symptoms including calf swelling, pain, and tenderness all the way to more severe presentations such as a pulmonary embolism (PE) from a dislodged clot. The management is based on disease characteristics, vital signs/clinical appearance, and the presence of medical comorbidities. In patients with bleeding risk or comorbidities, inpatient hospitalization for DVT management may be warranted; however, well patients with no symptoms suggestive of PE who are not ill can be managed outpatient with oral anticoagulants. Novel anticoagulants such as rivaroxaban or apixaban require 1 simple daily dose and do not require regular monitoring and are ideal for healthy patients who want to simplify their anticoagulant management. Figure/Illustration A depicts a lower extremity DVT with non-compressibility of the vessel and visualization of the thrombus within the vein (red arrow). Incorrect Answers: Answer 1: Alteplase is a thrombolytic which would only be indicated in a massive PE which would present with hypoxia, syncope, and unstable vitals. Answer 2: Heparin is appropriate inpatient management of a DVT; however, this patient only requires simple outpatient management of her DVT. Answer 3: Observation is inappropriate as this patient's DVT requires a course of anticoagulation to avoid the risk of a PE. Answer 5: Warfarin takes several days to take effect and requires INR monitoring and is less ideal for a healthy patient who also is generally not reliable for follow up/taking her medications. Bullet Summary: Novel anticoagulants are appropriate management of DVT in healthy patients (in particular when they prefer simple dosing).
3.8
(19)
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