Wed3November0919PM 1

An 18-year-old woman presents with an acute pulmonary embolism in the ninth week of pregnancy.

Which is the most appropriate treatment for this patient throughout her pregnancy?

(Please select 1 option)

Warfarin

Subcutaneous low molecular weight heparin (LMWH) Correct

Subcutaneous unfractionated heparin

Aspirin

Intravenous unfractionated heparin

Explanation

Anticoagulation with subcutaneous heparin is recommended in most guidelines with LMWH being a suitable alternative. The latter has the advantage of requiring no monitoring but is a less well established therapy in pregnancy.

She cannot be treated with intravenous (IV) heparin throughout her pregnancy and warfarin is also contraindicated due to teratogenicity.

Aspirin provides no demonstrable prophylactic value for venous thromboembolism.

Further Reading:

Royal College of Obstetricians and Gynaecologists (RCOG). Thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the Risk (Green-top Guideline No. 37a).

Answer Statistics

1

3%

2

84%

3

5%

4

1%

5

8%

Times answered: 305