Question of the Week # 95

Q95). A 62 year old man with history of  DM Type II and Coronary Artery Disease presents to the Emergency room with right leg pain and swelling.   The pain and swelling started 2 days ago and has been increasing. He denies any fever, chest pain or shortness of breath. He was recently admitted to the hospital 10 days ago for Non ST elevation Myocardial infarction. The patient was treated at that time with medical management that included Heparin, Clopidogrel, Aspirin and Beta blockers. The patient was discharged with instructions to continue aspirin, clopidogrel and metoprolol. At the time of discharge. his labs were all with in normal limits. He says he has an appointment with his cardiologist’s office next week for further work-up. He denies any bleeding. Physical examination reveals ankle tenderness and mild swelling of the right lower extremity up until his mid thigh. Laboratory investigations reveal a WBC of 5100, HGB 14.2 and a platelet count of 40k/µl ( N = 160 to 400k/µl. Prothrombin time and partial thromboplastin time with in normal limits. A venos doppler reveals a common femoral to popliteal DVT in his right lower extremity. Next step in managing this patient ?

A) Start Low Molecular Weight Heparin

B) Start Warfarin

C) Place Inferior Vena Cava Filter due to bleeding risk

D) Start Lepirudin

E) Platelet Transfusion

Which of the following is most likely to establish the diagnosis in this patient?

A) Lupus Anticoagulant Profile

B) Anti Platelet Factor 4/ Heparin antibodies

C) Factor V leiden mutation

D) Prothrombin gene mutation

E) Peripheral Blood Smear

 

7 Responses

  1. d,b

  2. D (START LEPIRUDIN )
    B ( HEPARIN ANTIBODIES )

    HIT -2 is a well recognized complication of heparin therapy and can occur with LMHW. It usually presents with thrombosis. Bleeding is rare and platelet transfusions are usually not necessary.

  3. i think answers are :
    C and C i am very thankful for your attempts to strengthen our medical background .. keep in touch with best regards.

  4. me too.. d n b

  5. A and B

  6. D&B

  7. D,B

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