A 50 year old African American Man comes to the ER because his left leg is bothering him a lot.He has vague and generalised pain in his left leg.This is present both at rest and activity.There is also marked swelling of the left leg as compared to right lower extremity.He was recently discharged from the hopsital after being diagnosed and treated for DVT of left leg.Since his discharge he has been taking Warfarin 2.5mg daily in the morning.His INR in the ED is 1.4.Venogram recurrent venous thrombosis extending into IVC and internal iliac vein.He does not have any other illnesses or he is not taking any medications.At thsi point which of the following will you recommend for this patient?
(A) IVC filter
(B) Increase the dose of warfarin and bring INR to therapeutic range.
(C) Ask him to take warfarin dose at bed time.
(D) Discontinue warfarin and start thrombolytic therapy
sent by: DR. JASMINE, KARNATAKA, INDIA
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3 comments:
where I can find the answers for these?
gr8 site, good job....
well the most important concern is to prevent pulmonary thromboembolism since DVT is involving till IVC. IVC filter is treatment of choice to prevent this. changes in warfarin dose can be done later to prevent thrombosis to spread and bring INR to normal .
ANSWER IS A
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