A 58-year-old woman comes to the walk-in clinic with 2 days of right thigh pain. She has hypertension and her medications include chlorthalidone and lisinopril. She also has been told that she is pre-diabetic. Her BMI is 32 kg/m².
The patient's blood pressure is 152/80 mm Hg and pulse is 87/min. A tender, nodular cord is palpated along the inner upper-right thigh. There are no skin changes. There is no ankle edema.
Her previous laboratory results were notable for creatinine of 1.3 mg/dL and HbA1c of 6.7%.
Which of the following is the best next step in managing this patient?

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11ec193a_983a_5584_853d_73d6c4465c39_MD0002_00 This patient's presentation suggests superficial vein thrombophlebitis (SVT). SVT is due to risk factors similar to those of deep venous thrombosis (DVT), such as venous stasis, venous excision/ablation, and malignancy. Patients typically present with tenderness, pain, induration, and/or erythema along the superficial vein with possible palpable nodular cord. SVT is generally benign and self-limiting, but it can coexist with or be complicated by DVT and pulmonary embolism. Some studies cite a prevalence of 6-53% for coexistence, 2.6-15% for propagation, and 0-33% for (asymptomatic) pulmonary embolism. Patients with high risk of developing DVT (Table) require further evaluation with duplex ultrasound before decision on treatment. Patients without DVT can be treated for SVT with leg elevation, warm or cold compresses, and NSAIDs for 7-10 days (Choices A and D). These patients require serial physical examinations to document resolution of SVT. Patients with DVT on ultrasound require treatment with anticoagulation and further investigation for causes such as hypercoagulable state or malignancy (Choices B and E). Anticoagulation for SVT is also considered in patients at increased risk for DVT, including those with superficial vein thrombosis > 5 cm, anatomic proximity of thrombus to the deep venous system (< 5 cm), and medical risk factors. < Educational objective: Superficial vein thrombophlebitis has similar risk factors to deep venous thrombosis (DVT) and presents with tenderness, pain, induration, and/or erythema along the superficial vein with possible palpable nodular cord. Ultrasound is indicated to rule out DVT in patients with superficial vein thrombosis > 5 cm, anatomic proximity of thrombus to the deep venous system (< 5 cm), and medical risk factors. < __________ References: How I treat superficial venous thrombosis. (http://www.ncbi.nlm.nih.gov/pubmed/20980677)

A 58-Year-Old Woman Comes to the Walk-In Clinic with 2