Clexane before pregnancy

[CJB]

Hi everyone,

Have only recently been diagnosed with PSD and have found this website very helpful, especially when you have so many questions swimming round in your head. I have tried looking through all the posts to see if I can find an answer to this one.

Has anyone out there ever started Clexane injections before falling pregnant? Particularly after recurrant miscarriage.

My Haematologist is discussing my case with his colleagues as he has only ever had 3 patients with PSD and so does not have a lot to go on.

Any thoughts would be greatly appreciated.

Thanks

Claire

[orangefoot]

Hi Claire

I think the usual way is to start inject as soon as you get a positive pregnancy test or as soon after that as you can. I think that doctors re reluctant to recommend injecting prior to a positive test as no-one can say which cycle will be successful and how long you might be waiting to fall pregnant. The risk of LMWH are small but still not one to take without certain benefit.

I am not sure at what stage our blood's coagulation makes a difference to the embryo. Perhaps you could ask your doctor and this might also shed light on the timing of using LMWH.

I began injecting at 5wks and I think that is a common time regardless of previous pregnancy experience. If you have recurrent loss and PSD your treatment will be no different to someone who has Factor V Leiden or any other clotting disorder and loss which your haematologist an obstetrician may have more experience of.

Good luck!

Rachel

[CJB]

Hi Rachel

Thanks for coming back to me. It seems from all the reading I have done here this is the general course of action. So I guess we just wait and see now!

Best wishes

Claire

[Guest lsg3001]

Hi Claire,

I am also new to this site and I have found it really helpful (this is my first post after reading it for 3 months!). I was diagnosed with PSD 8 years ago and was taking warfarin until I became pregnant and at 5 weeks they switched me to Lovenox injections. I live in the USA (originally from Scotland) and have heard this is a common substitute for Clexin. I suffered a miscarrage after a few weeks but it was decided to keep me on Lovenox since I want to keep trying to become pregnant. Warfarin is such a hard drug to stabalize it was agreed that it was easier to keep me on injections (and remain optomistic!) for at least a few months. Net, net. I have not heard of any issues from being on the injections before you fall pregnant (the inverse for the baby actually), but I was told they don't like to keep people on injections becuase it is harder (and more painful) to self inject and it is also a lot more expensive treatment (esp in the USA).

Personnaly I much prefer the injections due the known issues that warfarin can cause the fetus. It is not supposed to do any harm until after 5weeks but it just made me so nervous the first time that I am more comfortable on the injections and knowing I am safe if I do get pregnant.

I hope that helped and wish you all the luck in the future.

Lxx

[orangefoot]

L

You are absolutely right that you can't take warfarin while trying to conceive so if you are taking it long term you need to stop and inject before conception.

However, for those who are not on lifelong warfarin the risks of anticoagulation outweigh the benefits preconception or at any other time or we would all be injecting all the time iyswim.

Sending you sticky vibes

Rachel

[CJB]

Hi L

Thanks for your input.

My haematologist (and his colleagues) decided he would wait for a positive test before starting Clexane as he says there is no medical eveidence to say it helps beforehand. He also keeps telling me that there is no evidence to say there is a link between PSD and early pregnancy loss. So I guess I will wait and see.

Good luck and best wishes

Claire

[orangefoot]

A haematologist who doesn't connect blood clotting disorders with pregnancy loss? Really? He can't do much research in that area then.

Hoping for a positive test for you,

Rachel

[colletteg]

Hi Ladies

I think this opinion from haematologists must be quite common. Despite known PSD and previous miscarriage 2 different haematologists from different health authorities would not prescribe me clexane until I'd had a viability scan after a positive test, this being at 7 and 9 weeks respectively. The gestation of the test was dictated by the waiting list for the scan rather than any urgency to help prevent the loss of a pregnancy!

Fingers crossed and to all trying for a positive test. Sticky dust all round.

Collette xxx

[Juwels Morrison]

Hey just was wondering what the difference is from lovenox, clexane and fragmin? I am 5 weeks and can not afford the lovenox shots wich i also took with my two prior pergnancies! I am hoping to find something cheaper and still affective...does anyone know if you can take heprin through you whole pregnancy? that is soooo much cheaper!!!

Thanks julie.

[orangefoot]

Hi Julie! Long time no see!Ccongrats on your new little speckle

Lovenox, Fragmnin and Clexane are all LMWHs and I think the only difference is dosing. Fragmin is once a day Lovenox twice and Clexane I think is also once but I'm not sure.

You can do 'straight' heparin through pregnancy bit that it definitely twice a day and increases your risk of bleeding a little bit over LMWH which is why the LMWHs are now prescribed more often.

I'm so glad I don't have to battle with insurers to get medication here.

[Juwels Morrison]

Hey Rachel,

Thanks for your reply! I'm freaking out a little about this money issue!! I have an appointment with the ob tomorrow. I hope we can work something out.

Ya it has been a really long time huh?

Gwenny is already 3 1/2 yrs and my little one is 1....this one is a big surprise!!! Hy hubby just had a vasectomy 2 weeks ago to make sure this wouldn't happen!!! O well, whats meant to be will be, right?

When I was on lovenox before I took it once a day, I'm going to look into how much the fragmin and clexane would cost.

Did you start on thinners the day you thought you were pregnant or at 15 weeks?

Julie

[CJB]

Hi Ladies

I am 7 weeks now and my Haematologist started me on a low dose (20mg) of Clexane a couple of weeks ago. Colette a little similar to you he also wanted to wait until I had a viability scan initially but then decided he would put me on a low dosage based on what he had done with another patient previously. He then proposes to up it to 40mg after the scan if everything OK and continue with it right the way through pregnancy.

Before getting the positive test I did ask him was it a matter of cost as to when he started the Clexane and he assured me it was not as Clexane was inexpensive. I seem to remember something in the region of 30pence per 20mg. So Julie I don't know how much Lovenox costs but it may be an alternative for you if available.

Good luck to you all.

Claire

[orangefoot]

Julie, I started injecting at 5 weeks. I got a positive test and booked an appointment straight away. What would life be like if there were no surprises eh?

Claire, how are your injections going? Are you managing ok?

[CJB]

Hi Rachel

Yes the injections seem to be going Ok thanks. The odd day I get the angle a little wrong and it hurts a little but in general it's been going surprisingly well. It helps reading about others experiences and it also distracts the attention from the waiting for the viability scan!

Can I ask did you ever have any blood loss when taking Clexane in pregnancy? I seem to remember my Haematologist mentioning I am more likely to bleed, but now that I think of it I am not sure whether he meant just when you cut yourself. I have read some of the posts on here where other ladies have had bleeding a lot of the way through pregnancy so at the moment I can't tell whether this is normal for Clexane or whether it is the early signs of another miscarriage. (The hospital can't really advise at the moment so guess will have to wait and see and speak to the doctor tomorrow.) I didn't have anything like this when I had my first child.

Anyway lets keep everything crossed.

Claire

[kazza0371]

Hi everyone

Just wanted to get your thoughts on this one... Just found out I am pregnant (just under 5 weeks) but as I have had 3 miscarriage's previously I am under St Mary's recurrent Miscarraige clinic in London. This is where I found out about my Protein S defiency. Each time I have miscarried it has always been at 5 weeks, so why won't St Mary's give me an aoppointment for a scan until 6 weeks to get claxine and an ultrasound? I have been completley in tears to the hospital but they won't budge (apparently until they see a pregancy they won't give me Claxine)... I feel what's the point? Yes I'm on asprin but was on that with my last pregnancy and still miscarried at 5 weeks. Has anyone got a view on this? Help!!!!!

Karen x

[orangefoot]

I have not had any losses but my heart goes out to you for your suffering.

For my last pregnancy I was under the high risk Silver Star team a the John Radcliffe in Oxford and I called them as soon as I had a positive test. They weren't in a rush to book me in but when I did get an appointment they prescribed the LMWH that same day which was just at 5 weeks. I was injecting because I had a DVT not because I had any problems maintaining a pregnancy so the priority was to keep me safe from further clots once the pregnancy hormones kicked in and increased my own risk of clotting.

When I went again at just before 12 weeks they couldn't find a heartbeat with the doppler audio scanner and the OB advised me that I should have a scan because "There is no point upping the LMWH dose if there is no baby"

The baby was there, just very low down but that comment hurt me at the time. I can see their logic but it is not what you want to hear is it?

I think the problem is that they can't have you injecting before they see a little bean because at what point could they choose to start? It could be after ovulation but you may not have conceived on that cycle so that would be 14 days injecting a medication which you didn't need. Also I believe that the vascular systems that are the beginning of the placenta forming appear at around 5-6 weeks so any loss previous to that is not believed to be clotting related because there are no blood vessels to clot.

Despite LMWH being a life saver it is still a medication which is not without its risks and benefits so they make decisions based on its usefulness in each case and whether it will make a difference or not without causing undue harm to you.

I hope this time you can get to 6 weeks.

[erinadil]

Hi, I have never posted on here before. But I have recently been diagnosed with PSD. I am 27 and have not ever been pregnant. Nor have I had any clots. I requested that I be tested for PSD because of my family history and tested positive. Because of my history and INR levels, my hematologist has me on warfarin now. However, she wants me on Lovenox as soon as my husband and I want to try and have babies. In fact, no trying until we switch meds. She said she absolutely did not want me to get pregnant while on the warfarin. From this post I gather that she is much more proactive about this than most other doctors. And her plan is not the norm.(The cost factor is definetely prohibitive too. Still trying to figure that out) My OB really has no idea about PSD so I feel very hopeful that my hematologist is going to take good care of me. It is a scary time to know that things can go wrong and all the information we can gather is helpful. Hope all goes well for you. I will be thinking about you.

[orangefoot]

Hi Erin

If you are taking warfarin already then yoru doctor is not unusual in recommending that you inject prior to conceiving.

The reason for this is that you are considered to be at risk of clotting even under 'normal' circumstances so anti-coagulation is necessary at all times. Warfarin can cause foetal abnormalities so it is very important not to take warfarin when trying to conceive hence your doc's advice.

If I were to ttc again I would also have to stop warfarin and move to LMWH like you but kazza's situation is a bit different to ours.

[kazza0371]

Thanks for both of your replies...Is's nice to know that someone is there. I contacted my Hemotologist the day after and he saw me immediately and put me on Clexine there and then(with no scan). He couldn't beleive that with my past miscarraiges St Mary's were not prepared to put me on them straight way. So great, have Clexine now and at least I slept easier knowing I was getting help. What made me laugh is that St Mary's called me the same day (as I had asked to speak to a consultant, and not the nurse or the receptionist) and he agreed that I should be on Claxine ASAP after I mentioned I was put on it by my hemotologist... Can you believe that, even after the letter they sent my doctors stated after my scan!

Just shows that sometimes we just have to push! God it makes me so cross, I have PSD but have never had any symptoms and have never been on any medication. I just hope this does the trick xx

[erinadil]

Orangefoot,

Thanks for the response. I have not been diagnosed for more than a couple of months and am still trying to understand. In fact, this site and these forums are what convinced me to have myself tested. Thanks everyone!

Erin

[orangefoot]

Hi Kazza

It is such a relief to know that you are doing something and not just waiting for fate. I'm glad they have listened to you and put their fixed plans aside to treat you the way you want.

How are you doing with injecting? I have some tips which I will paste here so anyone can have a look. Some might work for you and some not but however your belly looks I hope you have a little bean growing in there soon.

Lie down and bend your knees so your feet are flat against your comfortable bed.

Make sure the bubble is at the plunger end of the syringe not near the

needle end. Hold the syringe like a pencil with your thumb and middle

finger with your first finger on the plunger. The bevelled edge of the

needle should be face up.

Pinch a good inch of skin somewhere low

on your belly - you'll lose sight of this part of your belly after a

while so its good to use it while you can.

At this point you might want to remind yourself to take a few breaths and relax!

Poke your skin a bit with the needle. If it hurts a lot poke another place

until you find a bit that doesn't feel too stingy. There are some

places where the nerves seem to be more 'alert' than others - honestly.

Once you have found a good place tilt the needle to a 45 degree angle and

push the needle in as far as it will go. Now hold very still and press

the plunger with your first finger as slowly as you can. Once you have

pushed in all the liquid and you have only bubble left pull the needle

out and let go of your skin. And keep remembering to breathe!

Good luck and do come and tell us when you have good news.

[kazza0371]

Thanks Orangefoot for your top tips...

But I'vs started to miscarry again last night so going up to the hospital today, obviously not meant to be

Kazza x

[orangefoot]

Oh Kazza, I'm so sorry. Hugs to you.

[CJB]

Hi Kazza

So sorry to hear of another loss for you. I hope you are trying to stay positive. I have been through something similar, and when under the care of St Mary's last year they gave me a prescription for Clexane (40mg) in advance of falling pregnant. They said should I fall pregnant then I could start injecting from day 1 of getting a positive test. So if you are still trying then it is worth speaking to them again to see if they will do this for you.

Good luck!

Claire

[zafyri]

I know that insurances are different around the world, so I'm not sure if this will help many people.

here in the states there are programs that people can apply for when they can't afford their prescriptions. The injections are very cost prohibitive and my doctor's nurse helped me fill out the paperwork in order to get a discount. They assist in getting insurances to reduce out of pocket expense, and/or help to pay some or all of the cost. I was fortunate enough to then not have to pay anything.

for now, as I've started on injections for my pregnancy, my insurance is covering the cost of my injections, but come January 1, I will have to start paying on them again. Knowing this, my husband and I are trying to save up some money now to help cover the cost then.