An 80-year-old man was admitted to the hospital with a 2-month history of painful swelling of his right lower extremity. His medical history was remarkable for metastatic prostate cancer, radical prostatectomy, androgen deprivation therapy with goserelin acetate (a gonadotropin-releasing hormone analogue used to treat prostate cancer, breast cancer, and endometriosis), and radiation therapy for cancer recurrence with bony metastases. He had no history of claudication. The patient had undergone right total hip arthroplasty 6 months previously and lower back surgery 3 months later. Two months before admission, he noticed right leg swelling. Lower extremity ultrasonography (US) performed elsewhere reportedly showed right deep venous thrombosis (DVT). Anticoagulation was initiated with warfarin and low-molecular-weight heparin (LMWH) bridging. An international normalized ratio (INR) determination performed 6 weeks before the current admission revealed a value of 9.0; warfarin therapy was discontinued, and the patient was lost to follow-up.
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