Question of the Week # 431

431) A 25 year old G2P1L1 at 32 weeks gestation presents with right leg swelling and pain progressively increasing over the past two days. Her previous pregnancy was uneventful except for uncomplicated C-section and she has a 2 year old healthy male child. Past medical history is negative for any significant health issues. There is no family history of clots or cancer.  Physical examination is consistent with 32 week gestation. Right lower extremity is swollen about 3cm more in calf-circumference when compared to the left. There is tenderness in right calf. A Doppler ultrasound reveals thrombosis in superficial femoral vein. Factor V leiden mutation, Lupus anticoagulant, anti-cardioloipin antibodies, prothrombin gene mutation are negative. Anti-thombin III is within normal limits. She is scheduled for C-section in 6 weeks. Which of the following is the most appropriate Statement concerning her management?

A)     Since this is not deep vein thrombosis, start her on LMWH ( Low Molecular Weight Heparin) at prophylactic doses

B)      Start warfarin and continue for total 6 months

C)      Start LMWH, discontinue 2 days prior to C-section, start unfractionated heparin followed by discontinuation 4 hrs prior to C-section and then start LMWH 12 hrs after surgery followed by Warfarin for 6 months.

D)     Start LMWH, discontinue 2 days prior to C-section, start unfractionated heparin followed by discontinuation 4 hrs prior to C-section and then start LMWH 12 hrs after surgery followed by Warfarin for 6 weeks post-partum

E)      Start LMWH now through delivery followed by warfarin for 6 months post-partum.

15 Responses

  1. start her on LMWH PROPHYLXIS AND STOP 48HRS BEFORE DELIVERY THEN START HER ON WARFARIN POSTPARTUM FOR 6MONTHS

  2. a, tx for prophylaxis this is not a dvt,

  3. D

  4. D

  5. E.

  6. option d , because lmwh is better option for abdominal surgery cases and a 6 week course of warfarin post op , I think will be adequate enough given the superficial location of the thrombosis .
    Eager to know the answer !!

  7. sorry , a correction I meant to write Unfractionated is better option for abdominal surgery cases .

  8. The answer is A

  9. C-is the answer i think.

  10. If this is for prophylaxis it would be for 6 weeks postpartum so the only answer with that is D

  11. whats the correct answer for this question?

    • Y, we need the answer as recently warferin can be given in preg after 1st 13 weeks. invite probable answer with reference….welcome
      tulsi656, email– mbsnp12@gmail.com

  12. I think we are dealing with a case of DVT in pregnancy. The superficial femoral vein is synonym with femoral vein. According to the last ACCP guidelines (February, 2012), anticoagulants should be continued
    for at least 6 weeks postpartum (for a minimum
    total duration of therapy of 3 months). So I think the answer D is the correct one

  13. d

  14. D

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