Step 2

Hematology 3

A 60-year-old man with a history of Type 2 DM, HD and CKD Stage 3 is admitted to the medical ICU secondary to septic shock. He remains hypotensive with SBP below 90 despite IV fluid resuscitation. He is then started on norepinephrine (Levophed) via a central line placement in the left internal jugular vein (LIJ). Soon after the placement of the central line, the patient’s left upper extremity is swollen and tender with 2+ pitting edema. An ultrasound of the left upper extremity shows that patient has a deep vein thrombosis (DVT). He has no history of previous DVT’s.

What is the next best step in the management of this patient?

  • A) Start the patient on low molecular weight heparin (Lovenox) for 3 months
  • B) Start the patient on low molecular weight heparin (Lovenox) indefinitely
  • C) Start the patient on low molecular weight indefinitely and switch to rivaroxaban (Xarelto)
  • D) Start unfractionated heparin and bridge to warfarin for a total of 3 months
  • E) Start unfractionated heparin and bridge to warfarin indefinitely

Authors

Serena Tharani

Editor

Dr. Raj Dasgupta

Last updated

Jan 08, 2023

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