CASE

A 45-year-old obese lady presented in medical OPD with the complaints of painful
swelling of right leg for 3 days. She feels severe tenderness in calf muscles with redness
on the skin for 5 days. She had no co-morbidity. She further told the doctor that
everything was alright till last week when she returned from Canada.

On examination; vitals were stable.

Local examination; right leg swollen as compared to left leg. Superficial veins of grade III
were prominent with redness seen on the right calf, skin warm to touch and tenderness
was present. Peripheral pulses were palpable.

Systemic examination was unremarkable.

Blood was drawn and sent for investigations. CBC normal, PT 12 seconds.

She was immediately sent for duplex scan that showed a clot in right femoral vein.

She was admitted. Physician advised; injection heparin 100 IU/ kg subcutaneously OD.

After 2 days the patient was shifted on tab warfarin 1mg OD, then its dose was titrated
to 5mg to achieve INR of 2.5. She was sent home on tab warfarin 5mg OD and tab
Aspirin 75mg OD, with an advice to come back in OPD after 3 days with INR report.