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
Dr. Raj Dasgupta