Lovenox Questions (Long)

KikiCohen · April 2014

At my 6 week check-up, my OB suggested going on Lovenox with future pregnancies based on my missed m/c and IUGR with P (I was diagnosed formally at 35 weeks, though it probably started around 32; P was born at 3 1/2 pounds at 37 weeks). I have a mild case of Raynaud's Syndrome, which is an autoimmune disorder. Testing on my placenta showed nothing and I have had major autoimmune bloodwork done twice (once in 2011 when I was diagnosed with Raynaud's and again about a year ago when I was 28 weeks with P).

From my own research, I feel like she may be jumping the gun. I see a vascular specialist for my Raynaud's and he said that since my case is so mild, he just doesn't think that it is related. He suggested Procardia as an alternative b/c that's what he would put me on if my symptoms warranted it (which they don't). I looked it up and it's class C for pregnancy. Obviously, I realize he's not an OB. Also, it seems like Lovenox is prescribed in cases where women have more severe autoimmune disorders or clotting disorders. There's no evidence that I have either one. In addition, a woman on my BMB was on Lovenox with her pregnancy and was actually given extra monitoring and told that Lovenox can cause IUGR. Well it makes no sense to me to take a drug that can cause what it's trying to prevent.

Basically, I'm just looking for your input. Why were you prescribed Lovenox? From what I've described, does it sound to you like Lovenox would be warranted? I have an appointment at the end of the month to discuss a plan for TTC#2 and plan to ask a ton of questions.

Wifey xo · April 2014

I was on Lovenox from my FET(frozen transfer), until 6 weeks postpartum. I delivered twins at 18 weeks and massive clotting was found, and subsequently diagnosed with two clotting disorders. Still, they thought it was incompetent cervix, but just called it the perfect storm. So, I had a cerclage, and did Lovenox at a prophylactic level daily, plus aspirin. The hematologist monitored my blood to make sure I did not need more, and my cervix was monitored weekly. I was also on 5 months of rest. My point is, we were way over cautious because we had no frame of reference. Now I have a son, and if we go forward with our embryos again, we would go with the same strict game plan because it worked. With frequent growth checks, I would imagine you could determine if the lovenox is working for you by baby's percentile. If they feel it is worth trying in your particular medical case, I would say why not try to change something that is not working optimally.

KikiCohen · April 2014

@LovelyRitaMeterMaid Thanks for your response. I'm actually told by both my OB and my vascular specialist that women with my type of Raynaud's don't have a higher risk of m/c. There are two types: one that exists with other autoimmune issues and one that exists in isolation. I have the latter.

@PugLife5869 Don't regret what you said lol You are actually echoing my thoughts about the situation. I will absolutely take Lovenox if that's what is ultimately recommended. I just want to make sure we're not making a pretty hefty decision without considering other options. If you don't mind me asking, how did they find out that you had Protein C deficiency. Like I said, I've had autoimmune workups done twice, but I guess I don't actually know what all they were looking for.

@Wifeyxo I'm so sorry for the loss of your sweet twins

So they didn't know about your clotting disorders until after your loss? May I ask how they diagnosed you? Just based on the clots that they found or by some other testing? My thought is, if my IUGR was due to a clotting issue, they would have found it when testing my placenta (I would assume?).

Wifey xo · April 2014

After my loss, they found clotting in one placenta that had migrated to my other son. In my case, they felt it was more likely the cervix because it was checked two weeks prior, and I had no indication anything was wrong until the sac dropped suddenly. It was all very quick. The very large clots were not seen by the MFM. They sent 14 vials of blood for testing and found a prothrombin gene mutation and PAI-1, from one parent (also undiagnosed). The hematologist then came into the picture for my second pregnancy. I did IVF, and unfortunately, this testing is not routine, and I had no idea after flying 300 hours a year and on birth control for a decade. The hematologist was pleased with the lovenox level and that my son was in the 90th percentile throughout. I did the generic. I'm someone who resisted medical intervention until I really saw how life changing it could be. In my case, I still question if I really need the cerclage but know I definitely need lovenox, but since the formula got my son here safely, my position is that if it is more than I need, so be it, I don't want to find out. Good luck with your decision, I am all about being your own advocate and not saying yes without questions. iPad/ no paragraphs

KikiCohen · April 2014

@PugLife5869 No need to apologize! Your "word vomit" is actually very, very helpful to me. If it turns out that I do need Lovenox with future pregnancies and am fortunate enough to get pregnant again, it's nice to know I have ladies with experience that can help me through

Carolee · April 2014

I was on Lovenox with L...I saw a hematologist after testing positive for Lupus Anticoagulant and he ran every blood test under the sun. Nothing stood out and he still told me I had to be on Lovenox. L was on the smaller side (10th percentile for weight) and I don't know if that is related to the Lovenox or not. I'd never heard of Lovenox causing IUGR - I thought it prevented it.

KikiCohen · April 2014

Carolee said:

I was on Lovenox with L...I saw a hematologist after testing positive for Lupus Anticoagulant and he ran every blood test under the sun. Nothing stood out and he still told me I had to be on Lovenox. L was on the smaller side (10th percentile for weight) and I don't know if that is related to the Lovenox or not. I'd never heard of Lovenox causing IUGR - I thought it prevented it.

I thought it prevented it too and never had heard anything about it causing IUGR. After the mom on my BMB said that, I did some research and I did find some other cases of it potentially happening. I'm not sure how you would go about "proving" that anyway. It is something I at least want to bring up to my OB just to be sure. Thank you for your response!

katharine25 · April 2014

I was on Lovenox my entire pregnancy. the party line was that it was for homo MTHFR, and the original RX was from my RE. My MFM thought it wasn't necessary, that my real problem was I had auto-immune anti-bodies (sjrogens) and that was treated by being on prednisone for the first trimester. I discussed going off Lovenox at my 24 week appt. with my OB as suggested my by MFM, and her answer was, it doesn't hurt and something is working so why stop.
The only possible side effect my son suffered from me being on Lovenox was a blue ball when he was born. Our pedi at first though it might have been a twisted testicle, but after a few ultrasounds it was determined that it was just a birth trauma amplified by blood thinners. Basically a big bruise. The bruising was gone by his 4 month appointment.

The only other real factor was that my MFM wouldn't let me go past 40 weeks. (orginally he wanted 39 but I argues to 40) and I had u/s almost every other week - all of which were perfect. Aside from that, I consider myself to have had a picture perfect pregnancy and delivered a healthy baby who scored a 9/9 on the agpar.

Currently the plan is when we start to TTC again, to basically do the same thing for the next pregnancy, which will include Lovenox.

KikiCohen · April 2014

@katharine25- How were the antibodies found? Through bloodwork? I'm assuming that these were part of what my doctor was looking for both times I had the autoimmune work ups done. They didn't find anything either time, so I guess that's why I'm questioning my OB's thoughts about Lovenox. Maybe I'll ask for the bloodwork to be done again so we can see if anything has changed. Also, were you on Lovenox up until delivery? I'm probably going to need a RCS (though I'm holding out hope for a VBAC) and my OB said I would need to stop it a few weeks prior.

katharine25 · April 2014

My RE found the antibodies. My ANA's came back positive so they dig deeper to find out what was causing them to be positive. Interestingly enough, I had my pcp test for he same antibodies like 2 weeks before I became pregnant with DS and they were gone. They still treated me like I had them the entire pregnancy (and we're never tested for again) - my MFM said they were something that come and go based on multiple factors. I had a laproscopy just a few months before the second round of testing so that might be why they were gone. (There a school of thought that endometriosis is actually an autoimmune disorder - or something like that. ) but really, the prednisone is what was treting that, not the lovenox. The lovenox was supposedly because of the MTHfR which is not agreed upon as actually being a loss cause (though I'm sure many women, myself included, disagree with that)
Any whoooo.... More to the point, the RE I went to ran really extensive testing. Much much more so than most RE's and definitely more than most OB's.

I was on lovenox until 37 weeks, when they switched me to heparin which is shorter acting in case I went into labor naturally (you can't get an EPI with lovenox, you can with heparin as they can reverse it or something like that.) I landed up being induced, so just stopped heparin 24 hours before I checked in for the induction. I was supposed to continue of the stuff for 6 weeks post partum, but I ran out of it at home at 1 week and never got around to refilling my prescription, so I just stopped. I'm still alive

KikiCohen · April 2014

PugLife5869 said:

I will butt in because I had a planned C. Typically they will switch you to heparin at the end in case you go in to labor. Since mine was planned and at just over 37 weeks they just had me take the lovenox the morning before and then had to come in early for blood testing to ensure my levels were where they wanted them to be for the C. I know not all docs do it like this but there wasn't much risk of me going into labor at that point. If there is any worry that you would, like if you will go up to 39 or 40 weeks before your C they probably will switch you to heparin. It has a much shorter half life and can be reversed with other mess if need be.

My OB said that I would be a candidate for a VBAC providing I don't have growth problems again. The office I see is a little notorious for choosing against doing VBACs (or so I've heard, obviously haven't had that experience yet), so I guess we'll see when/if the time comes.

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