Thursday, July 31, 2008
Stopping Lovenox
As someone who has the potential for a clotting disorder but who has had no actual outward signs of a clotting disorder, except for four miscarriages, the lovenox/heparin was administered to give me some peace of mind and because I continued to insist upon it. Over the course of this pregnancy and before, I'd read that most physicians stop the lovenox/heparin at around 36 weeks. When I asked my doc about this yesterday - he said between 34 to 36 weeks was fine. The Husband then asked how will we know if there's a problem and the doc said that essentially, we won't. But he also said the likelihood of there being a problem is very, very remote. This unfortunately gives me little assurance because, hey, you know, this is my kid! Today, unfortunately, I started in on doctor google and found out that most people were switched from lovenox to heparin at around 36 weeks because the effects of the heparin can be stopped easily via medication. In other words, if I had to have a c-section or an epidural, there would be little to no concern that I would bleed out if I switched back to heparin. Again, I was of the mind that I had to stop it completely. If you've had experience with heparin/lovenox during pregnancy what did you do? I'm very concerned about what this could mean if I cease taking it - but recognize that it could have no effect at all.
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I don't have any personal experience with this, but I think Farah at Fertilized took both. Her blog is http://fertilizeme.blogspot.com/
I had a weird gum bleeding episode around 32/33 weeks and that is when my OB took me off the heparin. She said at this point, the risks of a clot were small (esp. since I had no history of clotting and was just on the heparin b/c of my MTHFR mutation). My OB did run some labs to see what my platelet count was and they also ran this before my c-section. Platelet levels have to be at a certain level for surgery. I'm also the exception since I got HELLP syndrome which lowers your platelets. I just barely made the cutoff.
I was SUPER nervous about stopping the heparin too!! I was all worried about something going wrong, but my OB kept telling me that the risks were very minimal.
After suffering 3 recurrent miscarriages and being diagnosed with a blood clotting disorder, my Dr. put me on aspirin - they didn't feel heparin, etc. was necessary. I was told to go off it between 34-36 weeks. At 32 weeks I was given a stress test on a weekly basis. When I went off the aspirin at 36 weeks, I had a second weekly appointment for a biophysical u/s. The Dr. assured me that these tests would detect any clotting issues affecting the baby before they would become a problem. I was still very nervous/anxious to stop the aspirin. However, it did give me a lot of reassurance to have these tests. I also checked with other high risk specialists and they supported the Dr.'s plan. You should ask for -insist on- additional monitoring once you get off of the blood thinner. You'll still be nervous but you'll have more moments of calm. Best to you.
Hey Alice- Don't you just love the blogosphere!! My OB switched me from Lovenox to Heparin at 34 weeks because Heparin has a shorter half life in your body. It has about a 6-12 hour window versus Lovenox that has a 20-24 hour window. I am very glad that i did switch to heparin because I went into labor at 36w6d (water broke) I had to wait a few more hours before I could have an epidural because of the Heparin in my system (if you are thinking about epidural that would be the only thing to consider- on lovenox - you can not have most pain meds until the lovenox is out of your system). I was switched back to lovenox right after birth .. They gave me a shot of it a few minutes after delivery. I was on lovenox for 7 weeks after delivery and am now told to take a baby aspirin for the remainder of my life. If you have any more questions or comments or want any more info - email Farahbeth at gmail
I personally have no actual experience with a blood clot other than I too am MTHFR homozygous and had three miscarriages before conceiving my daughter. I just took baby aspirin throughout my pregnancy and had no problems at all. My girlfriend developed a blood clot at 8 weeks pregnant in her lung and was put on Lovenox until 36 weeks then heparin until 6weeks postpartum. Not sure if any of this is useful info. I would think you are fine to stop the Lovenox now but do what you feel comfortable with. BTW I am totally impressed that you didn't post one single complaining post about taking the Lovenox. You are a tough cookie!
My RE said that by 34-38 weeks, the blood vessels should be large enough so that if there WAS a blood clot, it would not cut off blood flow. I stopped at 36 weeks with the baby aspirin and the Lovenox because I was having false labor. I was hesitant to stop, but my OB assured me that it is really most important in the first trimester, when the blood vessels in the placenta are very small.
Some REs even stop at the end of the 2nd trimester because statistically those that continue to take it during the 3rd get no more of a real benefit.
My doc's usual protocol is to stop the Lovenox/Arixtra at 37.5 weeks and induce at 38. I didn't want an induction and chose to be switched to Heparin at that time so that I can wait this baby out.
I was only on lovenox for 1st tri. This was for TH1/2 ratio which was crap, and to stop little clots which embryo rejecting launches.
The theory was that once the placenta was fully functioning the whole rejection thing was gone...
So, no answers I am afraid but certainly wisging you luck!
I don't know if it's too late...but I am in the same situation and currently 36 weeks...
I'm on Lovenox due to a previous stint with blood clots in my lungs from BC pills...I haven't had ANY problems since then, but as a precaution I will have to take the injections during pregnancy and 6 weeks afterwards...and nothing more.
We chose induction so that there was a huge chance of me getting an epidural.
My doctor's are making me stop 1 day before induction and are putting me back on 12 hours afterwards. I also was made aware today that as soon as I'm admitted, I will be in compression boots.
Hey...So what happened? Did you stop taking Lovenox? Was everything successful. I am in the same position now and am too scared to stop. I also have had no history of the clotting disorder but experienced 6 miscarriages and since on lovenox I am 34 weeks pregnant. My doctor suggested I stopped but I havent had the strength to take the chance.
Dawn--
I did stop and our son was born on October 18th! All is well.
Thanks for posting!
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