A 30-Year-Old Primigravida at 18 Weeks Gestation Comes to the Office

A 30-year-old primigravida at 18 weeks gestation comes to the office due to left calf pain and swelling that developed after a 4-hour car trip.  The pain is worse with ambulation.  The pregnancy was complicated by first-trimester bleeding.  A recent ultrasound showed an 18-week-sized fetus with normal anatomy and no placenta previa.
Examination shows 1+ pretibial edema with pain elicited on plantar flexion of the left lower extremity.  The remainder of the examination is unremarkable.
A lower extremity compression ultrasound with Doppler shows a thrombosis in the left popliteal vein.
Which of the following is the best treatment strategy for this patient?

A) Inferior vena cava filter placement
B) Intravenous recombinant tissue-type plasminogen activator
C) Oral factor Xa inhibitor
D) Subcutaneous low-molecular-weight heparin
E) Subcutaneous unfractionated heparin

Correct Answer:

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