Mrs. D is a 54-year-old female who completed chemotherapy and radiation treatment recently for breast cancer. She had a bilateral mastectomy at her choosing. During her concurrent treatment, she developed a deep vein thrombosis (DVT) in her right leg, which was found by venous doppler. She was treated with Lovenox injections until her warfarin level was therapeutic in the 2-3 INR range. Her INR has been within range majority of the time. She returns to the clinic for a post-treatment follow-up; she is still on warfarin. She complains her right leg is slightly swollen, painful, and erythemic.
She has recently returned to work, so she admits she is more active, and on her feet more overall, but also more sedentary, as her work requires her to sit for long periods of time. She has taken acetaminophen, but it has not helped her new right-leg pain. She is fearful she has another clot in that leg. She denies any shortness of breath or chest pain. There are no issues in the other extremities.
Her past medical history is significant for obesity, hypertension, peripheral vascular disease, and metabolic syndrome.
Family history is positive for blood disorders (uncle) and ovarian cancer (sister).
Vital signs as follows:
Temperature: 98.0 degrees Celsius
Blood Pressure: 142/76
Spo2: 98% on room air
Pain Level: 7/10
Her complete blood count and basic metabolic profile are within normal limits today, as is her INR at 2.3.