Part 4: Venous Thromboembolism
Elisabeth M. Battinelli, MD, PhD
Assistant Professor of Medicine, Harvard Medical School, Associate Physician, Division of Hematology, Brigham and Women's Hospital, Boston, MA
Jean M. Connors, MD
Assistant Professor of Medicine, Harvard Medical School, Medical Director, Anticoagulation Management Service, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
A 56-year-old man presents to the emergency room for sudden onset of shortness of breath and is determined to have an acute PE. His family history is significant for multiple relatives with colon cancer. The patient is a marathon runner and denies any recent period of immobilization, air travel, or illness. He states that he leads a very active lifestyle and that his shortness of breath came on suddenly. The patient asks about what might have caused him to have this thrombotic event. Since the patient has an acute thrombosis, the emergency room team explains that they will refer the patient to a hematologist for a hypercoagulable workup at a later time.
One month later, you see this patient in the hematology clinic and he again asks if he has any risk factors that led to this spontaneous thrombotic event. Which of the following is the most appropriate next step in the management of this patient?