A patient is at 12 weeks' gestation with her first baby. She has cardiac disease, class III. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. The nurse's response should be:

Question

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Heparin is preferred over Coumadin during pregnancy because it does not cross the placenta and has a lower risk of causing fetal complications. Coumadin can cause fetal abnormalities and bleeding. Although heparin is typically given by injection, there are newer oral anticoagulants (such as apixaban) that can be used instead of Coumadin during pregnancy. The cost and effects on iron absorption are not relevant factors in this decision.

A Patient Is at 12 Weeks' Gestation with Her First