American Board of Internal Medicine (ABIM) Certification Practice Exam

What treatment options are available for a patient with venous thromboembolism who wishes to breastfeed?

1. Low molecular weight heparin or dabigatran

2. Warfarin or low-molecular-weight heparin

3. Apixaban or rivaroxaban

4. Heparin infusion only

The correct answer is: Warfarin or low-molecular-weight heparin

For patients with venous thromboembolism who wish to breastfeed, low-molecular-weight heparin (LMWH) is considered the treatment of choice due to its safety profile during lactation. LMWH, such as enoxaparin, has minimal transfer into breast milk and is not known to harm the breastfeeding infant. Warfarin, while effective for the treatment and prevention of thromboembolic events, is not recommended in breastfeeding mothers during the first month postpartum due to its potential effects on the infant. After the first month, some studies suggest that warfarin may be compatible with breastfeeding, but careful consideration and monitoring should be taken into account. In contrast, LMWH can provide effective anticoagulation while being safer for the infant in terms of breastfeeding. Dabigatran, apixaban, and rivaroxaban, while effective oral anticoagulants, are considered less suitable options for breastfeeding patients due to insufficient safety data regarding their effects on breastfeeding infants. Heparin infusion would also limit the mother's ability to manage her condition effectively, particularly since LMWH can be administered subcutaneously and allows for more flexibility with regard to breastfeeding. In summary, prescribing low-molecular-weight heparin provides an