A 45-year-old male with a recent history of orthopedic surgery presents to the emergency department with a swollen, painful right calf. His vital signs are stable and he denies chest pain or shortness of breath. What would be the BEST next step in the management of this patient?
Advise elevation of the extremity and application of a warm compress.
Order a duplex ultrasonography to assess for presence of a thrombus.
Initiate anticoagulation therapy immediately to prevent clot propagation.
Perform a D-dimer test to rule out deep vein thrombosis.
The clinical presentation is suggestive of a deep vein thrombosis (DVT), especially given the recent surgery, which is a significant risk factor. The most appropriate next step is to perform a duplex ultrasonography (venous ultrasonography) to confirm the diagnosis. While D-dimer testing is useful in ruling out DVT in patients with a low probability, its high sensitivity and low specificity make it a poor diagnostic tool in patients with a higher probability of DVT. Anticoagulation therapy should not be initiated without diagnostic confirmation, and elevation of the extremity is a supportive measure but not diagnostic.
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