A saddle pulmonary embolism

A 25-year-old woman who was referred to the Anticoagulation Management Service at Thika Level 5 Hospital November 2008 had been taking warfarin (INR range 2.0-3.0) since having a saddle pulmonary embolism in July 2007. Her previous medical history included antithrombin III deficiency, protein C deficiency, factor V Leiden mutation, and a family history of thrombophilia. She was not taking any other medications. Under the care of the Anticoagulation Management Service, her INR was maintained within the therapeutic range with a total weekly dose of warfarin 86 to 91 mg. She was adherent with warfarin therapy and reported missing 1 or 2 doses per year. She indicated a desire to become pregnant, with plans to try to conceive in early 2012. In collaboration with the Obstetric Medicine Clinic, the clinic instructed her to continue taking warfarin while attempting to become pregnant and to perform pregnancy tests every 1 to 2 weeks. In May 2012, she reported a positive result on a pregnancy test, and it was determined that she was at 4 weeks’ gestation.