The patient receives warfarin (Coumadin) and becomes pregnant. The physician changes her anticoagulant to enoxaparin (Lovenox). She asks the nurse, "Why did the doctor do that?" What is the best rationale by the nurse?
1. "Because it is easier to maintain your bleeding times in a therapeutic range."
2. "Because warfarin (Coumadin) is known to cause serious cardiac defects."
3. "Because you are less likely to have bleeding with enoxaparin (Lovenox)."
4. "Because enoxaparin (Lovenox) cannot get into your baby."
Correct Answer: 4
Rationale: Heparin and the low-molecular-weight heparin (LMWH) molecules are too large to cross the placental barrier. The patient would not be less likely to have bleeding with enoxaparin (Lovenox). Warfarin (Coumadin) is not known to cause serious cardiac defects. It is not easier to maintain bleeding times with enoxaparin (Lovenox) than with warfarin (Coumadin).
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