Question of the Week # 259

259)  A 32 year old woman presents to your office after she discovered that she is pregnant based on a positive home pregnancy test. A repeat urine Beta-HCG is positive in the office. Her past medical history is significant for recurrent deep vein thromboses and homozygosity for  Factor V leiden mutation. She has been on coumadin for the past three years. Her physical examination is benign with out any clinical evidence of deep vein thromboses. You advice her to stop coumadin. You prescribe unfractionated heparin at a dose of 5000 IU twice daily  to be used through out her pregnancy . This patient is at risk for which of the follwing?

A) Hypokalemia

B) Fetal malformations

C) Vertebral fractures

D) Complete abortion

E) Thrombocytosis

9 Responses

  1. c

  2. Heparin induced osteoporosis

  3. E………Patients on UH has risk of hemorrhage, osteoporosis, and antibody-mediated thrombocytopenia. Although most data regarding these advantages come from the nonpregnant population, it is plausible to speculate that these traits also are present in pregnant women . But in the setting of pregnancy, thrombocytosis due to HIT is most common and acute onset than osteoporosis producing vertebrar fraction.

  4. eee

  5. C) Vertebral fractures

  6. heparin induced thrombocytopenia and thrombosis , but not thrombocytosis—words are tricky


  7. C) heparin induced osteoporosis, heparin induced thrombocytopenia and thrombosis. not thrombocytosis

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