Are additional studies warranted for diagnosis or determining therapy?
A 7 1 -year-old woman presents with I day of headache and left-sided weakness after complaining for several days of dyspnea and confusion. Her history is notable for nonvalvular atrial fibrillation and hypertension; she denies any prior history of thrombosis or bleeding. Her medications include a beta-blocker and warfarin (coumadin). Examination is notable for partial […]
A 37-year-old woman presents to the emergency department with a swollen, tender left calf and dyspnea.
A 37-year-old woman presents to the emergency department with a swollen, tender left calf and dyspnea. She noted the development of symptoms 3 days ago, the day following her arrival on a plane trip from Austral ia to the United States. She admits to pleuritic chest pain but denies cough or fever, and has no […]
What coagulation tests should be done at this point?
The patient presents with a high-probability clinical picture for venous thrombosis and pulmonary embolism (PE), given the swollen left calf, positive Homans sign (calf pain on simultaneous extension at the knee and flexion at the ankle), and several signs of PE including pleuritic pain, tachypnea, the friction rub, and a low oxygen saturation without fever […]
The patient demonstrates several risk factors for thrombosis, including oral contraceptive use, a recent long airplane trip (venous stasis), and a presumptive family history of an inherited thrombophilia (father is on anticoagulation therapy)
The patient demonstrates several risk factors for thrombosis, including oral contraceptive use, a recent long airplane trip (venous stasis), and a presumptive family history of an inherited thrombophilia (father is on anticoagulation therapy). This will require further testing but not as a prerequisite to beginning appropriate therapy. Based on the radiological studies, the patient has […]
A 57-year-old woman, scheduled for an elective hysterectomy, is referred for management of her anticoagulation during the perioperative period.
A 57-year-old woman, scheduled for an elective hysterectomy, is referred for management of her anticoagulation during the perioperative period. She is currently receiving warfarin 3 mg daily for a 5-year history of atrial fibrillation with past evidence of a single embolic event. Other medical problems include hypertension and diabetes, controlled with an angiotensin-converting enzyme (ACE) […]