MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d). On physical examination, vital signs are normal. Cardiac auscultation demonstrates a normal mechanical S1. There are no murmurs or added sounds. Her INR is 2.6. Which of the following anticoagulation regimens will provide the greatest protection against thromboembolism during her pregnancy? A. Continue warfarin and aspirin B. Stop warfarin and start dabigatran C. Stop warfarin and start subcutaneous fixed-dose unfractionated heparin D. Stop warfarin and start weight-based low-molecular-weight heparin Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Cardiology OB/GYN Source Type: blogs