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1st June 2023
A 69-year-old man attends the emergency care centre complaining of a red, swollen, painful right leg
A 69-year-old man attends the emergency care centre complaining of a red, swollen, painful right leg. Examination of his respiratory, cardiovascular and abdominal systems are normal. He is saturating at 97% on air, RR is 15 and BP is 134/76.
US Doppler scan confirms the diagnosis of DVT in the common femoral vein. His renal function is normal and he is commenced on apixaban for the treatment of the DVT. He denies any provoking factors, including no recent immobility, no recent long-haul flights, no recent surgeries, or trauma.
On further questioning, the patient mentions that he has a history of smoking 30 cigarettes a day for over 40 years. He also mentions some weight loss of 5kg over the last few months.
Blood tests are listed below:
| Hb | 173 g/L | Males: (135 – 175 g/L) |
| Platelets | 350 x 10⁹/L | (150 – 400 x 10⁹/L) |
| WCC | 5 x 10⁹/L | (4 – 11 x 10⁹/L) |
| Na+ | 134 mmol/L | (135 – 145 mmol/L) |
| K+ | 4.2 mmol/L | (3.5 – 5.0 mmol/L) |
| Urea | 5.6 mmol/L | (2.5 – 6.5 mmol/L) |
| Creatinine | 69 μmol/L | (50 – 120 μmol/L) |
| CRP | 8 mg/L | (0 – 10 mg/L) |
| LFTS | Unremarkable | |
How should this patient’s care be managed next?
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