Case 93 – update 1

Our patient has a confirmed proximal DVT and we recognised the important points in the clinical evaluation by looking for provoking factors:

  • Malignancy
  • Family history
  • Periods of immobility
  • Recent surgery or hospital stays
  • Hormonal therapy or pregnancy
  • Nephrotic syndrome
  • Autoimmune or other inflammatory disorder

In our patient nothing obvious came to light. He’d been on a short train journey and his cousin also had a DVT – neither enough to make us wonder about a convincing risk factor.

He needs treatment for the DVT. His renal and liver function are normal.

Questions

  • How do you decide which anticoagulant to use?
  • What risks and side effects would you tell him?
  • What investigations may you wish to perform to look for causes of VTE?

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