{"id":10145,"date":"2026-06-01T00:05:58","date_gmt":"2026-06-01T08:05:58","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10145"},"modified":"2026-06-30T13:44:47","modified_gmt":"2026-06-30T21:44:47","slug":"usmle-step-1-question-of-the-day-thromboprophylaxis-medication","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Thromboprophylaxis medication"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Today\u2019s USMLE\u00ae Step 1 question of the day features a postoperative patient with a new laboratory abnormality after knee arthroplasty. Which medication is the likely cause, and what\u2019s its mechanism of action? Let\u2019s find out!<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 70-year-old woman is admitted to the hospital for left total knee arthroplasty. Past medical history is notable for hypertension, hyperlipidemia, and osteoarthritis. Preoperative laboratory testing is obtained. The surgery is performed without complications. Medications for thromboprophylaxis and pain management are administered postoperatively. Seven days following the procedure, a repeat complete blood count is obtained and compared with the preoperative results, as shown below. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The medication most likely responsible for this patient\u2019s laboratory abnormality has which of the following mechanisms of action?<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory Value<\/strong>&nbsp;<\/td><td><strong>Results (at admission)<\/strong>&nbsp;<\/td><td><strong>Results (current)<\/strong>&nbsp;<\/td><\/tr><tr><td>Hemoglobin&nbsp;<\/td><td>15.2 g\/dL&nbsp;<\/td><td>15.0 g\/dL&nbsp;<\/td><\/tr><tr><td>Hematocrit&nbsp;<\/td><td>46%&nbsp;<\/td><td>45%&nbsp;<\/td><\/tr><tr><td>Leukocyte Count&nbsp;<\/td><td>9,000\/mm<sup>3<\/sup>&nbsp;<\/td><td>8,800\/mm<sup>3<\/sup>&nbsp;<\/td><\/tr><tr><td>Platelet Count&nbsp;<\/td><td>150,000\/mm<sup>3<\/sup>&nbsp;<\/td><td>65,000\/mm<sup>3<\/sup>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Blockade of ADP-dependent platelet aggregation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Inhibition of cyclooxygenase<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inhibition of glycoprotein IIb\/IIIa<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Inhibition of the carboxylation of coagulation factors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Activation of antithrombin<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Activation of antithrombin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Blockade of ADP-dependent platelet aggregation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Medications such as clopidogrel inhibit ADP-dependent platelet aggregation. Common side effects include rash and diarrhea. Ticlopidine, an older agent, works via a similar mechanism and can result in neutropenia. However, it would be unusual for any of these medications to cause thrombocytopenia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Inhibition of cyclooxygenase<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Aspirin, celecoxib, and NSAIDs (e.g., ibuprofen, naproxen) work by inhibiting cyclooxygenase enzymes. Side effects include increased risk of bleeding, kidney injury, and interstitial nephritis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Inhibition of glycoprotein IIb\/IIIa<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Glycoprotein IIb\/IIIa inhibitors (e.g, abciximab, tirofiban, and eptifibatide) work via inhibition of glycoprotein IIb\/IIIa. These agents can cause acute-onset thrombocytopenia that manifests within 24 hours of starting the medication. In contrast, this patient\u2019s thrombocytopenia was detected almost a week after starting these medications. Moreover, glycoprotein IIb\/IIIa inhibitors are rarely used for clotting prophylaxis after surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Inhibition of the carboxylation of coagulation factors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Warfarin inhibits vitamin K-dependent carboxylation of clotting factors II, VII, IX, and X. Side effects include increased risk of bleeding, transient hypercoagulability, and skin necrosis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Heparin is commonly used for deep vein thrombosis prophylaxis in hospitalized patients. It activates antithrombin III, which in turn inactivates factors IIa and Xa, accounting for heparin\u2019s anticoagulant effects.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>One toxicity is heparin-induced thrombocytopenia (HIT), characterized by a fall in platelet count and a hypercoagulable state. <\/strong>The condition arises when platelet factor 4 (PF4), a substance released from the alpha granule of platelets, binds with heparin molecules. This complex is immunogenic and may cause the formation of antibodies against the heparin-PF4 complex.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The antibodies then activate platelets, resulting in the microthrombi formation and an overall reduction in the platelet count. <\/strong>The microthrombi can damage a variety of organ systems, including the heart, kidneys, and skin. In addition, antibody-coated platelets are consumed by macrophages, further reducing the platelet count. <strong>The reaction usually occurs 5-10 days after heparin initiation and is often associated with a fall in platelet count of 30% or more.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>If a patient experiences HIT, heparin should be immediately discontinued. Alternative anticoagulants (e.g., argatroban, fondaparinux) should be initiated to disrupt microthrombi formation.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"806\" height=\"434\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/image.png\" alt=\"Educational diagram explaining heparin-induced thrombocytopenia (HIT). It shows heparin binding to platelet factor 4, triggering an immune response that produces antibodies, leading to platelet destruction, low platelet count, and increased risk of thrombosis. It also notes that heparin should be stopped and replaced with alternative anticoagulants such as direct thrombin inhibitors (e.g., argatroban, bivalirudin, dabigatran).\" class=\"wp-image-10148\" style=\"width:518px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/image.png 806w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/image.png?resize=300,162 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/image.png?resize=768,414 768w\" sizes=\"auto, (max-width: 806px) 100vw, 806px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Heparin activates antithrombin III, which inactivates factor IIa and factor Xa. Heparin-induced thrombocytopenia (HIT) is a severe adverse effect that arises due to the formation of antibodies against the heparin-PF4 complex. HIT usually occurs 5-10 days after heparin initiation and is associated with a 30% or more decrease in platelet count.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Heparin-induced_thrombocytopenia\"><strong>Heparin-induced thrombocytopenia<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Nicolas, D., Nicolas, S., Hodgens, A., Reed, M. (2020) \u201c<strong>Heparin induced thrombocytopenia<\/strong>\u201d. StatPearls [Internet]. Web Address: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482330\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482330\/<\/a><\/li>\n\n\n\n<li>Onishi, A., St Ange, K., Dordick, J.S., Linhardt, R.J. (2016) <strong>Heparin and anticoagulation<\/strong>. Frontiers in Bioscience. 21, 1372-1392. Doi: 10.2741\/4462.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Want more <strong>USMLE\u00ae Step 1<\/strong> <strong>practice questions<\/strong>? Try <strong>Osmosis from Elsevier<\/strong> today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a><\/em>&nbsp;and discover why millions of current and future <strong>clinicians <\/strong>and <strong>caregivers <\/strong>love <strong>learning by Osmosis<\/strong>.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A postoperative patient develops a concerning drop in platelets after starting thromboprophylaxis. Can you identify the drug mechanism behind this clinical scenario?<\/p>\n","protected":false},"author":208,"featured_media":10150,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[3109,3107,2967,3108,3110,3114,3106,3113,84,462,261,3111,1307,3112,664],"class_list":["post-10145","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-adverse-drug-reactions","tag-anticoagulants","tag-board-exam-prep","tag-clinical-vignette","tag-drug-mechanisms","tag-exam-questions","tag-hematology","tag-hospital-medicine","tag-medical-education","tag-osmosis","tag-pharmacology","tag-platelet-disorders","tag-thrombocytopenia","tag-thromboprophylaxis","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Thromboprophylaxis medication - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-thromboprophylaxis-medication\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Thromboprophylaxis medication - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A postoperative patient develops a concerning drop in platelets after starting thromboprophylaxis. 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