Chapter 18: Venous Thromboembolic Disease
TAKI GALANIS, MD; LUIS H. ERASE, MD, FSVM; ALEJANDRO PEREZ, MD, FSVM; and GENO J. MERLI, MD, FACP, FSVM
A 58-year-old man is scheduled for a hemicolectomy for colon cancer. You are asked to see the patient in preparation for surgery. The patient has a medical history of stable coronary artery disease, hypertension, diabetes mellitus, DVT at age 42 following right femur fracture, and hyperlipidemia.
Medications include simvastatin, 40 mg daily; lisinopril, 20 mg daily; metformin, 500 mg twice each day; and ASA, 81 mg daily.
Physical examination: BP 138/70, P 72, R 12, BMI 40. The heart has regular rhythm. S1 and S2 are normal. There are no carotid bruits. The lungs are clear, without crackles. The abdomen is obese, and bowel sounds are active. There are no masses or organ enlargement. The patient has varicose veins bilaterally, with hemosiderin pigmentation at the distal medial aspect of the extremities.