American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an important consideration regarding switched anticoagulants in the final month of pregnancy?

1. Switching from warfarin to low molecular weight heparin is standard

2. Switching from low molecular weight heparin to unfractionated heparin allows for safer epidural catheter placement

3. Low molecular weight heparin should not be used during pregnancy at all

4. Unfractionated heparin provides better protection against thromboembolism

The correct answer is: Switching from low molecular weight heparin to unfractionated heparin allows for safer epidural catheter placement

In the final month of pregnancy, managing anticoagulation is crucial to balance the risks of thromboembolism versus the risks associated with bleeding, particularly during labor and delivery. Switching from low molecular weight heparin (LMWH) to unfractionated heparin (UFH) is often done because unfractionated heparin has a shorter half-life, allowing for more precise control over anticoagulation levels. This is especially important if an epidural catheter needs to be placed. IF the LMWH is used, the timing of administration related to the procedure could pose a risk for bleeding due to the longer duration that LMWH remains in the system. Unfractionated heparin can be safely stopped a few hours before the procedure and restarted afterward, minimizing the risk of complications. This consideration allows healthcare providers to manage the patient's anticoagulation state more effectively around the time of delivery, ultimately ensuring both maternal safety and fetal well-being. In contrast, the other statements are not aligned with best practices regarding the use and timing of anticoagulation in late pregnancy.