ASCVD — EECC MCQ

Correct answer: A — Peak and trough anti-Xa-guided LMWH dose adjustment

The best answer is “Peak and trough anti-Xa-guided LMWH dose adjustment”. Pregnancy changes heparin pharmacokinetics, and mechanical mitral valves carry high thrombosis risk; both peak and trough anti-Xa assessment helps identify inadequate exposure. “Use a fixed weight-based dose without anti-Xa monitoring” is less appropriate because fixed dosing can become subtherapeutic as pregnancy progresses “Monitor INR to adjust low-molecular-weight heparin” is less appropriate because INR does not measure low-molecular-weight-heparin activity “Use platelet count alone to determine anticoagulant intensity” is less appropriate because platelet count detects complications but not therapeutic anticoagulation “Withhold anticoagulation whenever fetal ultrasound is normal” is less appropriate because normal fetal imaging does not reduce maternal valve-thrombosis risk

Reference: 2025 ESC Guidelines for cardiovascular disease and pregnancy. https://academic.oup.com/eurheartj/article/46/43/4462/8234487