Even More Swelling

A 65 year old woman is admitted for elective replacement of her left knee joint. Her preoperative FBC is as follows: WBC 7,000/mm3, Hb 12 g/dL, platelets 420,000/mm3. An ECG, CXR and fasting plasma glucose are normal.

Her medical and surgical histories are unremarkable, and she is not on any drugs.

Following an uncomplicated operation, she is started on DVT prophylaxis with subcutaneous enoxaparin. On the 5th postoperative day, she complains of pain and swelling of her left leg.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 8,700/mm3 (4,600-11,000)
Hb: 11.9 g/dl (11.5-18)
Platelets: 152,000/mm3 (150,000-450,000)
Compression USS L/LL

Performed

There is acute thrombosis of the left popliteal vein, with absence of flow and compressibility.
D-Dimers

Performed

D-Dimer levels are elevated.
PF4 antigen assay

Performed

The platelet factor 4 antigen assay is positive.

Select Relevant Management
Continue Enoxaparin
Start Argatroban
Start Warfarin
Place IVC Filter