Let's Talk About Lovenox

BookishMomma

Edit: I just realized that @jj32's post about heparin covers a lot of the same stuff. Gah! Sorry for the redundancy. I'm editing this to say that I'm particularly interested in the perspective of PGALers who are on Lovenox or heparin but do NOT have a known clotting disorder. Or the perspective from multiple loss ladies. 

I'll preface this by saying that I'm not yet on Lovenox, but am strongly considering starting it. 

For those who are mobile and can't see my siggy, I've had 1 live birth in July 2011 and then 4 losses since November 2013, all at less than 9 weeks. I met with my new OB today and she's GREAT. She didn't do any labs for me, since I've elected not to do betas this time around and I'm only about 4 and a half weeks along. This appointment was actually just supposed to be a "preconception consult," but then I got my BFP.

Anyway, the new doc reviewed my history and gave me a referral for a consult with an MFM, but I can't get in to see the MFM until Feb. 4. We talked about putting me on Lovenox in the meantime for a likely "unknown clotting factor." Basically, none of my clotting panels pointed to a diagnosed clotting disorder, but there's a family history of blood clots (my brother and uncle). I also had an SCH with my last loss, though who knows if any of that is related.

Anyway, the new OB said she's willing to write me an Rx for Lovenox in the meantime until I can get in to the MFM and discuss it more thoroughly. She told me quite frankly that normally she wouldn't do it without a diagnosed clotting disorder on record or without me seeing the MFM first, but since the wait is so long to see the MFM and now is a "critical time," and given my history, she said she trusts that I know the risks and benefits and would be OK writing the Rx.

I'm currently on Crinone 2x per day, baby aspirin, and extra folate. I do not know if I have MTHFR because none of my prior docs would test for it, saying it would not change their treatment plan. This doc is trying to push an order through my insurance for me to (finally!) get the MTHFR testing, but it may take a little while to get approval and to get the results. 

Am I crazy for wanting to inject myself with meds without a known clotting disorder? What would PGAL do? Ladies who take Lovenox--what do you take it for and do you believe it has helped?

mrsjg2013

I do not have experience with Lovenox- I did start taking a baby aspirin as soon as I got a BFP this time around even though my RE didn't find anything to hint at a clotting disorder.  If he had offered Lovenox and there were no risks involved in taking it, I know that my PGAL brain would deal with the pesky needles at the chance that it could help.  I had one explained and two unexplained losses, and so I was willing to try anything that wouldn't be harmful at the chance it could make the difference.  Baby aspirin and estrogen were my additions this time around (as well as continuing crinone).  I started estrogen supplements after the lab accidentally tested for estrogen and it was considerably low, even though he said that they don't typically treat for low estrogen and that it likely wouldn't make any difference. It's so hard to say whether the addition of extra meds help or not, but if you feel like this is something you should try, I say go for it.  I'm so glad that your new OB is so supportive, and I hope that the MFM appointment next month goes just as well!  ((HUGS)) to you lady!

*edit: clarification

BookishMomma

Thanks so much for your persepctive @mrsjg2014. Only one of my losses is explained (chromosomal abnormality). That's interesting about the estrogen. I've never had my estrogen levels tested. 

mrsjg2013

@BookishMomma said:

Thanks so much for your persepctive @mrsjg2014. Only one of my losses is explained (chromosomal abnormality). That's interesting about the estrogen. I've never had my estrogen levels tested. 

I had never my estrogen tested either, and it was tested this time by accident.  However, you can bet your bottom that I will be asking for it to be tested and will be taking the estrogen supplement if it's at all low for any future pregnancies.  My RE explained that typically, low estrogen is an indicator that something else is wrong in the pregnancy... it's a symptom of loss, not a cause... but my TTC journey has been anything but typical, so I decided to take the supplement.  If you're getting any type of blood tests done with your OB/MFM, you could always ask for it to be tested to rule it out?  I took the supplement until somewhere between 12-14 weeks when I stopped taking the Crinone.  Once I was on it and they retested my estrogen, it took just a week for it to be up in the normal range. 

kreardon11

So glad you like your new OB! @Bookishmomma - Did you meet with Dr. Stephenson? 

I'll be stalking this post! We're TTC again and I have MTHFR as well. My doc only has me on BA, folate, and Vitamins. Doesn't think Lovenox is necessary but I want to push for it. 

BookishMomma

@meladoriestar I remember when you switched REs. Would you remind me what your clotting factor is? I've tested negative for APS (cardiolipins & beta 2 glycoproteins), lupus anticoagulant, prothrombin, antithrombin 3, Factor V, Factor II, protein C & protein S activity. I'm sure there are rarer ones out there that I haven't been tested for. 

I'm leaning toward going on the 'Nox.

BookishMomma

kreardon11 said:

So glad you like your new OB! @Bookishmomma - Did you meet with Dr. Stephenson? 

I'll be stalking this post! We're TTC again and I have MTHFR as well. My doc only has me on BA, folate, and Vitamins. Doesn't think Lovenox is necessary but I want to push for it. 

@kreardon11 No, this was an OB in my city. I still have my appt. with Dr. Stephenson on the calendar for the end of February. Really hoping I won't need it, but she's my contingency plan.

BookishMomma

meladoriestar said:

@meladoriestar I remember when you switched REs. Would you remind me what your clotting factor is? I've tested negative for APS (cardiolipins & beta 2 glycoproteins), lupus anticoagulant, prothrombin, antithrombin 3, Factor V, Factor II, protein C & protein S activity. I'm sure there are rarer ones out there that I haven't been tested for. 

I'm leaning toward going on the 'Nox.

Protein S. I guess because the levels drop during pregnancy if you get tested too soon after a loss it's easy to miss. So if you were tested for it within 6 weeks of a loss you should get retested (according to my hematologist).

@meladoriestar Hmmm, that's interesting. My Protein S level was tested on October 10, and I got a BFP just 5 days later. So I guess I sort of *was* pregnant at the time it was tested. Though it would have been so early on (we're talking just a few days DPO) so I'm not sure that it would have had much effect. But that's good to know. Regardless, my level was 80% and the normal range on the report says 60-140%. So I suppose I was on the low end of normal. If pregnancy decreases the level, then maybe it's possible I drop down into the deficiency zone during pregnancy... This JRSM article indicates it's at least a possibility.

I just heard back from my doctor and she's processing my Lovenox Rx. I'm doing it.

eta- link

SciChick

*****ticker warning*****

PAL lurker, living child ticker below

First of all, congratulations on your BFP!! Prior to DD being born I had three m/c, one was probably c/p, the other two were at 13w and 7-8w. I did the RPL and I was diagnosed with MTHFR. I didn't have the major clotting disorders but I did have elevated homocysteine levels and because of that I was prescribed Lovenox by my RE and then my MFM. One MFM said it wasn't needed, but he'd be willing to prescribe it if I absolutely felt I had to have it. The other said I needed it so that's the MFM I chose to work with. I took 40mg once per day. I also took Neevo DHA, which is folate and not folic acid. (Folgard didn't work for me the third pg and why would it? It's folic acid, not folate.) I had also had a hysteroscopy because after the 3rd m/c we discovered a blocked tube and my ute really needed a good clean out due to polyps and what was most likely some material left over from previous pregnancies. I only go into this much detail to let you know that the Lovenox/folate combo was not the only change that was made so it's impossible for me to say 100% that it was the Lovenox/folate but it sure looks promising. Personally, I would never move forward with a pregnancy without it.

I also think it helped with my BP - oh I took a baby aspirin too and calcium for that, as well as progesterone until week 14. So, again, it's not the only change but I do believe it helped a great deal. 

Personally, I'd say if you feel like you need it and the doc is willing to prescribe, go for it. Lovenox is the thinner of choice in pg more than Heparin because you don't have to switch it prior to delivery. If I remember correctly, all I had to do was to stop it the night before my c-section. Your MFM will give you the appropriate guidelines though if you do end up taking it. As you can see with your OB, you can advocate for yourself. Maybe it won't help, but I don't think it can do any harm so the potential for the help is worth it. The shot doesn't hurt that much, but it does bruise...they don't hurt, they just look awful. But that goes away too. I did also have to take the Lovenox for 6 weeks after delivery. If you need anything else, feel free to PM me and good luck! I'm so rooting for you!

KikiCohen

I am not on Lovenox, but after my pregnancy with DS, my OB very strongly considered it for this pregnancy.  Basically, I had later first tri loss and then developed severe IUGR with DS.  I had a boatload of testing done, including for clotting disorders and nothing was ever found.  I do have an autoimmune disorder called Raynaud's (long story short- my extremities overreact to cold and restrict bloodlfow) that we believe could have been related to both.  We ended up choosing to do baby aspirin instead and do careful growth scans to watch for IUGR.  If it looks like we're headed that way, I will be on Lovenox.

Basically, if your doctor supports it, I say go for it.  It can't hurt (other than the obvious lol).  Just double check if you can take Lovenox and baby aspirin at the same time.

Eliz77

Testing showed I have two copies of the MTHFR gene but what also pushed my RE to send me to a hematologist was the fact my mom has been having issues w/clots-DVTs-she does not have the MTHFR gene, supposedly. RE and hematologist said that while there are a lot of opinions on whether MTHFR can make you at risk for losses, there is speculation that even if we don't have the same blood clotting gene, they can be connected some way, and they didn't want to ignore that chance. I was on BA, lovenox (switched to heparin at 35 weeks) and folate for the pregnancy. 

Good luck tio you! I'm glad you like your new o/b, makes a huge difference when you are comfortable with your Dr!

BookishMomma

Eliz77 said:

Testing showed I have two copies of the MTHFR gene but what also pushed my RE to send me to a hematologist was the fact my mom has been having issues w/clots-DVTs-she does not have the MTHFR gene, supposedly. RE and hematologist said that while there are a lot of opinions on whether MTHFR can make you at risk for losses, there is speculation that even if we don't have the same blood clotting gene, they can be connected some way, and they didn't want to ignore that chance. I was on BA, lovenox (switched to heparin at 35 weeks) and folate for the pregnancy. 

Good luck tio you! I'm glad you like your new o/b, makes a huge difference when you are comfortable with your Dr!

@Eliz77 How much folate were you on? Do you mind sharing what brand you used?

Eliz77

I got it from my hematologist and it's called Methyl CPG. It contains 2mg of folate. My prenatal (Vita Fol) also contained 1mg of folic acid.

I mentioned this in the other thread-my hematologst  felt the biggest risk with MTHFR was 1st tri losses and had wanted me to stop lovenox in 2nd tri and not be on heparin. He was going to have me stop BA at 30 weeks. However, my o/b and RE vetoed that so I was on aspirin and lovenox until 35 weeks, then I switched to heparin. Hematologist still wants me on folate and to restart BA when I stop breast feeding. 

If you have any more questions, please ask!!

J&D2007

Lurker post*. I was just put on Lovenox at approx 5 weeks for this natural pg. I have no known clotting disorders or genetic problems at all. After many failed iuis and Ivfs, my RE just wanted to do anything possible to help this little one stick around. She just indicated that increased blood flow to the uterus certainly couldn't hurt! She also put me on a newer antihistamine protocol, which is thought to decrease overall body inflammation slightly (again, without a diagnosis of any inflammatory conditions). I take 5mg prednisone, Prilosec, Pepcid, and Claritin every day. BTW, as pp suggested the shot really isn't too bad. I do get little blood blisters and small spots of bruising occasionally but they go away. HTH!

kreardon11

jj32 said:

BookishMomma said:

Eliz77 said:

Testing showed I have two copies of the MTHFR gene but what also pushed my RE to send me to a hematologist was the fact my mom has been having issues w/clots-DVTs-she does not have the MTHFR gene, supposedly. RE and hematologist said that while there are a lot of opinions on whether MTHFR can make you at risk for losses, there is speculation that even if we don't have the same blood clotting gene, they can be connected some way, and they didn't want to ignore that chance. I was on BA, lovenox (switched to heparin at 35 weeks) and folate for the pregnancy. 

Good luck tio you! I'm glad you like your new o/b, makes a huge difference when you are comfortable with your Dr!

@Eliz77 How much folate were you on? Do you mind sharing what brand you used?

@BookishMomma‌ my RE gave me a script for Vitamed MD rx which has 1mg of Folate. I found some Folate on a website called Seeking Health, I was going to ask my dr about it.

Seeking health is AWSOME. My OB put me on 1g folate.

BookishMomma

Ladies, thank you so much! This is super helpful & makes me feel more confident about my gut feeling to go on Lovenox. The RX has been ordered & I should get it in the mail next week.

Eliz77

@BookishMomma I have no idea if this is normal protocol, but will you be seeing a hematologist as well? I had to go to him monthly for blood work and had some issues with anemia so he put me on an iron supplement and made me come every 2-3 weeks for a while. He would do bloodwork (CBC/chem and D-dimer), check my weight and blood pressure. And he was the one who wrote scripts for lovenox and heparin. Just curious if this was just what my RE did or a normal thing. I still am supposed to see him this month at what would be 8 weeks PP. I have no idea how much longer I'll see him-I just stopped lovenox today. 

BookishMomma

@eliz77 I'm not currently seeing a hematologist. But I imagine when I see the MFM they might refer me to one to manage the Lovenox & stuff associated with that. My OB definitely wanted me to be under the care of a specialist for it. She wrote me the Rx today because she knew I needed to start it sooner than later and that I wouldn't be able to get in with the MFM for a few weeks. But she was clear that clotting related stuff it is not her specialty area so she prefers I work with a specialist as well.

Eliz77

Good luck!! I started lovenox as soon as we confirmed an intrauterine pregnancy since I had history of EP, so like 6 weeks I think it was. FX this is the missing piece for you. ((HUGS))

kreardon11

jj32 said:

@kreardon11‌ have you tried their prenatal from Seeking Health? Or did you just take the Vitamed & extra Folate from SH?

I'm taking the vital nutrients prenatal + folate from SH. My OB and naturopath both were in favor of this.