Question

Following a 10 hour car trip, a 73 year old female develops left ankle swelling and acute shortness of breath. Ultrasound with Doppler of her left leg confirms the presence of deep venous thrombosis, and the patient is hospitalized and started on a heparin drip and oral warfarin. Two days later she is discharged from the hospital with subcutaneous heparin and warfarin. Shortly upon arrival home, she develops pleuritic chest pain and shortness of breath and presents to her physician. Physical examination reveals tachypnea and an oxygen saturation of 89% on room air. Laboratory analysis shows her activated partial thromboplastin time to be therapeutically increased, while her prothrombin time remains below the optimal therapeutic level. A ventilation/perfusion scan is obtained, which shows a large perfusion defect in the left lower lobe. Which of the following is the most appropriate intervention at this time?

A. Hospital admission for observation
B. Begin aspirin
C. Increase heparin
D. Increase warfarin
E. Placement of an IVC filter

Answer 1

The most appropriate intervention would be the placement of an IVC filter.

Step-by-step explanation:

The most appropriate intervention at this time would be E. Placement of an IVC filter.

The patient's symptoms, including pleuritic chest pain, shortness of breath, and large perfusion defect on the ventilation/perfusion scan, are indicative of a pulmonary embolism (PE). A PE occurs when a blood clot lodges in a pulmonary artery, causing a blockage. In this case, the presence of deep venous thrombosis (DVT) and the patient's symptoms warrant the placement of an inferior vena cava (IVC) filter, which is a device that can prevent blood clots from reaching the lungs.