Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 35-year-old pregnant woman with a history of pulmonary embolism

mksap
Conditions
November 23, 2013
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 35-year-old woman undergoes evaluation after home pregnancy testing indicated that she is pregnant. Her medical history includes a previous idiopathic pulmonary embolism. Her only medication is a daily prenatal vitamin.

On physical examination, temperature is 36.2 °C (97.1 °F), blood pressure is 110/65 mm Hg, pulse rate is 70/min, and respiration rate is 20/min. BMI is 25.

Results of a pregnancy test are positive.

Which of the following is the most appropriate venous thromboembolism prophylaxis for this patient?

A: Antepartum low-molecular-weight heparin (LMWH) and aspirin
B: Antepartum and postpartum LMWH
C: Antepartum and postpartum warfarin
D: No prophylaxis

MKSAP Answer and Critique

The correct answer is B: Antepartum and postpartum LMWH. This item is available to MKSAP 16 subscribers as item 43 in the Hematology and Oncology section.

This patient should receive antepartum and postpartum heparin. Patients such as this one with a previous history of idiopathic venous thromboembolism (VTE) are at a fourfold increased risk for recurrent VTE compared with patients with a history of triggered VTE. Although outcomes data are limited, it is currently recommended that pregnant women at moderate to high risk of recurrent VTE (as in this patient with a single unprovoked pulmonary embolism) receive prophylactic-dose or intermediate-dose low-molecular-weight heparin (LMWH) during pregnancy and for 6 weeks postpartum.

Prophylaxis with both low-dose aspirin and low- or moderate-dose unfractionated heparin or LMWH is indicated for women with recurrent fetal loss and the antiphospholipid syndrome. This patient does not have the antiphospholipid syndrome or previous fetal loss, and combined aspirin and heparin treatment is not indicated.

Warfarin is contraindicated during the first trimester because of the potential for warfarin-induced embryopathy. In addition, warfarin is rarely used in the United States during the second and third trimesters, generally because of the fear of liability in the event of any fetal adverse events, whether or not they are warfarin related.

Administering no prophylaxis to this patient with a high risk for recurrent VTE would not be prudent.

Key Point

  • Pregnant women with a history of idiopathic venous thromboembolism should receive antepartum and postpartum prophylactic anticoagulation.

This content is excerpted from MKSAP 16 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Will video replays lead to safer surgeons?

November 22, 2013 Kevin 4
…
Next

Don't resign your professional license in the midst of an investigation

November 23, 2013 Kevin 7
…

ADVERTISEMENT

Tagged as: OB/GYN

Post navigation

< Previous Post
Will video replays lead to safer surgeons?
Next Post >
Don't resign your professional license in the midst of an investigation

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • How medical culture hides burnout in plain sight

    Marco Benítez
  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • How functional precision oncology is revolutionizing cancer treatment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • When a doctor becomes the narrator of a patient’s final chapter

      Ryan McCarthy, MD | Physician
    • Why innovation in health care starts with bold thinking

      Miguel Villagra, MD | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...