66-year-old woman with a history of small-cell lung cancer presents for leg pain and swelling

A 66-year-old woman with a history of small-cell lung cancer presents for evaluation of left leg pain and swelling that started yesterday. She notes no falls or trauma and notes no chest pain or shortness of breath or hemoptysis. She has had no major bleeding events in the past. She does not smoke cigarettes, drink alcohol, or use illicit drugs. She does not take any medications and does not have any allergies.

Her vital signs are: blood pressure 110/80 mm Hg, pulse 75 beats/minute, respiratory rate 14, oxygen saturation 100% on room air, and temperature 99 °F. General physical examination is remarkable for left leg swelling to the inguinal region. The leg is cyanotic and dorsalis pedis and poster tibial pulses are hard to elicit.

A complete blood count, serum chemistries, and coagulation studies are obtained, and the results are within normal limits. Venous Doppler ultrasonography is obtained and shows massive iliofemoral deep venous thrombosis (DVT).

What is the next step in the management of this patient's condition?

• Initiate therapy with warfarin.
• Initiate therapy with unfractionated heparin.
• Initiate therapy with low molecular weight heparin and consult vascular surgery/interventional radiology for possible thrombolysis or thrombectomy.
• Initiate therapy with rivaroxaban.

This question appears in Med-Challenger Internal Medicine Exam Review with CME

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