Should Prophylactic Anticoagulation Be Considered with Large
A 47-year-old woman who was recently discharged from our institution after she was treated for pneumonia and anemia presented with complaints of left leg swelling and pain for 2 days. She had no history of recent trauma or recent travel. She was not on any oral contraceptive pills. She denied any history of prior thromboembolic events and there was no family history of DVT or cancer. Review of systems was positive for pelvic pressure, urinary urgency, and menorrhagia. Physical examination was remarkable for enlarged firm abdominal mass and left thigh and leg swelling with tenderness.

Laboratory findings were unremarkable except for hemoglobin of 6.9?mg/dL. Left lower extremity venous Doppler showed acute DVT in the left common femoral vein, femoral, profunda femoral veins, and popliteal and tibial peroneal veins. A computed tomography (CT) scan of the chest confirmed a left lower lobe lung PTE. An abdominal CT scan showed an enlarged uterus measuring 22 × 8.8 × 14?cm with numerous fibroids, the largest of which measured approximately 7?cm. The patient was treated acutely with unfractionated heparin and warfarin. Inferior vena cava (IVC) filter was placed to decrease the risk of perioperative pulmonary embolism. She was then evaluated by gynecology for treatment of the enlarged uterus. Patient was discharged home, but she never showed up for her follow-up appointment....