American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the anticoagulant treatment of choice during delivery?

1. Oral warfarin

2. Low molecular weight heparin

3. Intravenous unfractionated heparin

4. Direct oral anticoagulants

The correct answer is: Intravenous unfractionated heparin

During delivery, the anticoagulant treatment of choice is intravenous unfractionated heparin. This preference arises from several crucial factors that make unfractionated heparin the safest and most effective option during this high-risk period. Unfractionated heparin allows for rapid onset and quick reversal if necessary, which is particularly important during labor and delivery when the risk of hemorrhage can increase. In case of an emergency situation, such as the need for a cesarean section or other surgical intervention, unfractionated heparin can be readily discontinued, and the anticoagulant effect can be reversed by administering protamine sulfate if needed. Moreover, unfractionated heparin can be closely monitored through activated partial thromboplastin time (aPTT) tests, which helps ensure that the anticoagulation levels are within a safe therapeutic range. This level of monitoring is critical during the delivery process to minimize the risks of both thromboembolic events and bleeding complications. In contrast, other options such as oral warfarin and direct oral anticoagulants (DOACs) are not recommended during delivery due to their slower onset of action, difficulty in achieving rapid reversal, and increased risk of bleeding. Low molecular weight heparin