Progressively worsening left lower extremity pain, redness, and swelling over the past 5 days
History of Present Illness
This case will illustrate an example of a patient presenting with signs and symptoms of deep vein thrombosis and the thought- and decision-making process for selecting and managing anticoagulation therapy.
Drug Therapy Problems
Care Plan (by Problem)
What signs and symptoms of acute DVT does FJ have, and what objective information helps support a diagnosis of DVT?
Hint: See Prevention in PPP
What risk factors does FJ have that increases the risk of developing DVT?
Hint: See Table 11-1 in PPP
What oral anticoagulation options are available to treat FJ’s DVT, and what are some advantages/disadvantages of each option?
Hint: See Table 11-8, Figure 11-8, Treatment in PPP
Which oral anticoagulant do you recommend, why, and for how long? What parameters should be monitored?
Hint: See Table 11-13, Table 11-15, and Treatment in PPP
For the anticoagulant you chose, what counseling points will you provide and how do they compare with the other oral anticoagulants?
Hint: See Table 11-13, Table 11-14, Treatment in PPP
FJ completed her course of treatment. Four months later, the patient returns to the emergency department with worsening LLE pain, redness and swelling. What anticoagulation therapy and course of treatment do you recommend?
Hint: See Table 11-8 in PPP
Given the numerous treatment options available to treat deep vein thrombosis and venous thrombus embolism (VTE), it is challenging to devise an optimal anticoagulation therapy plan. One must consider and evaluate several factors to formulate a plan which increases the likelihood of successful treatment. Nowadays, the availability of direct oral anticoagulants (DOAC) and their general recommendation for first line use, has made managing and monitoring oral anticoagulation therapy relatively more straightforward, particularly for patients facing challenges with frequent laboratory monitoring and inability to present to clinic appointments. Although DOACs include once daily and twice daily therapies, consideration of a patient’s existing medication adherence, the impact of a new medication on their existing medication regimen and burden, and the safety profiles of each DOAC is paramount in plan development. All DOACs used for VTE require both initial and maintenance dosing phases and may even require a different medication altogether for initial therapy. Taking into consideration patients’ clinical and social situations will be key to the development of an effective, safe, and mutually agreeable oral anticoagulation therapy plan.