first question | choose another case | Epharnet

58- year old married Caucasian female, administrative worker.

Family history:
Father died of myocardial infarction at the age of 68, mother is healthy, but she has already had two episodes of venous thromboembolism. The first event was following cholecystectomy, the second one occurred in puerperium.

Personal history:
Since childhood the patient has been treated for a painful left hip joint. Otherwise she is healthy. She has had no surgery. She was admitted for a planned total hip replacement. Weight adjusted dosage of low molecular weight heparin ( LMWH ) - Fraxiparin ( Sanofi - Synthelabo ) - 0.4 ml s.c. 12 hours before surgery was given as prophylaxis for venous thromboembolism. The same dosage of Fraxiparin was administered 12 hours following surgery and for 3 consecutive days after surgery. Then the dosage was increased to 0,6 ml daily until the tenth day after surgery and after that this therapy was withdrawn. Four days after discharge she felt pain in her left leg and she also noticed swelling of this leg with a short episode of dyspnea. Because of these symptoms, she consulted an orthopedic surgeon.

Physical examination:
Patient without any signs of dyspnea, cyanosis or fever, body weight 80 kg, blood pressure 120/80, physical examination was normal except for swelling of the left lower extremity below the knee with a positive plantar and Homan's sign. The operation wound was healed, with no signs of the inflammation or bleeding.