For inpatient thromboprophylaxis during pregnancy, which drug is most appropriate.

• A. Low molecular weight heparin
• B. Warfarin
• C. Rivaroxaban
• D. Apixaban

Answer: (A)

In pregnancy, the safest and most effective option for inpatient thromboprophylaxis is low molecular weight heparin. It does not cross the placenta, so it protects the fetus from anticoagulant effects, while providing reliable, well-understood protection against venous thromboembolism for the mother. It has a predictable dose-response, usually requires little routine monitoring, and carries a lower risk of heparin-induced thrombocytopenia compared with unfractionated heparin, making it practical for inpatient use.

Warfarin crosses the placenta and is teratogenic, especially in the first trimester, leading to fetal malformations and bleeding risks, so it is avoided during pregnancy. Direct oral anticoagulants like rivaroxaban and apixaban lack sufficient safety data in pregnancy and are not recommended for thromboprophylaxis.