Would you do lovenox again?

Have you suffered from HELLP syndrome or had a pregnancy complicated by an underlying disorder? Discuss your concerns here
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Re : Would you do lovenox again?

Postby onthebrink » Wed Apr 22, 2009 07:57 am

Thank you all for taking the time to respond and also for the great research. What really sucks is all the "might"s and the "maybe"s and that what I see is that there isn't any conclusive evidence either way. I had two bad outcomes while on a blood thinner while other women see improvements. But who knows if those losses would have occurred without the blood thinner. It obviously didn't reduce my PE risk and in fact I had it earlier. My fear is if I do this again, and I feel like I have to, and I have a loss it will be my decision either way to do the injections or not so I will always feel like it is my fault. When I was first tested for these blood disorders I was about 6 weeks pregnant over 2 years ago. I wonder if pregnancy has any effect on those tests. I believe when I go in for my two week post d&c appointment I will ask for a repeat of the thrombophilia panel and also check my homocycteine leves. I also do have one copy of the MTHFR but they aren't concerned with that as my levels were good at the time. I would love to find another group of MFM physicians, but we only have two and my husband isn't comfortable with the location of the other group. And it is difficult to find a group of OBs that will take on a patient with such high risks. But I do believe I will see the advise of a hematologist as well.

Kbielec, I understand your need for more information, but a warning...it will drive you crazy. I wanted to be in control of any decisions made regarding my health care and I found that I just confused myself even more. Good luck to you and I am sorry for your loss.

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Re : Would you do lovenox again?

Postby caryn » Tue Apr 21, 2009 11:43 pm

I know that the Experts have said that the evidence surrounding treatment of various clotting disorders has grown weaker with time -- in other words, they used to think treatment would have more impact re: preeclampsia risk than it actually does -- but I don't know *which* disorders, exactly, are thought to benefit from injectables.

If I recall correctly, MTHFR is so very common in the population -- something like 20% of all women -- that it's no longer thought to be very well correlated with preeclampsia, but elevated homocysteine is probably thought to be correlated, and MTHFR can mean elevated homocysteine. (It's just that some women with MTHFR have normal homocysteine levels and some women without it have elevated levels.)

But that's MTHFR, and I don't recall anything in particular with Factor V Leiden. I did turn up this: http://www.ncbi.nlm.nih.gov/pubmed/18521490

...In a single study low molecular weight heparin seemed to have a positive effect on pregnancy outcome after previous single or recurrent abortions. Experience in prevention of pre-eclampsia by administration of prophylactic heparin is very limited. Data on pregnancy complications in women with known heritable thrombophilia or a history of thrombosis are inconsistent as well. These women usually have a favourable pregnancy outcome. CONCLUSION: Thrombophilia screening might be justified in women with pregnancy loss. Treatment with low molecular weight heparin might be considered for those with pregnancy loss and thrombophilia...

I'd ask your docs about the reasoning behind their treatment, and the possibility that the lovenox isn't just correlated with these two losses but contributing to them somehow, and see what they suggest. I'm a big fan of second opinions too. :-)

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Re : Would you do lovenox again?

Postby kbielec » Tue Apr 21, 2009 03:34 pm

I lost my baby last March from HELLP and Factor V. My specialist has said when I become pregnant that I will be on a daily blood thinner shot to help me get to a full term delivery...I am nervous - Just trying to gather some information.

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Re : Would you do lovenox again?

Postby haileysmom » Tue Apr 21, 2009 03:25 pm

so sorry for you losses. I have FVL hetero too. From my understanding having fvl hetero does not mean a woman would automatically need to be on a blood thinner during pregnancy BUT if there is a history of preg complications (PE, HELLP, stillbirth, multiple miscarriage etc.) than it may be recommended. It must be started early in pregnancy. I started @ 6 wks.

I was concerned about abruption too. I think there is some risk of abruption on blood thinner but I'm not sure what it is, maybe one of the experts can let you know. PE can cause abruption. I had placental abruption during my first preg which was from the pe/hellp. My dr told me w/ a low (preventative) dose of lovenox I wouldn't need to worry during my last preg.

If it makes you feel better maybe you should consult w/ another dr. I consulted w/ both a Peri and Hematologist. Best of luck you you!

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Re : Would you do lovenox again?

Postby blythe » Tue Apr 21, 2009 03:23 pm

Margaret, I am so sorry your babies died.

I'm no doc but I searched through our archives and some reputable google articles, maybe something I found will be helpful.

First, this article
CONCLUSIONS: (1) The morbidity of severe complications from high to low are: placental abruption, DIC, induced cardiopathy, renal failure, cerebro vascular accident and HELLP syndrome. (2) The main causes of mortality for gravida and puerperant are: cerebro vascular accident, HELLP syndrome, DIC and induced cardiopathy. (3) The major complications harmful to perinatal newborns are in the order of: placental abruption, HELLP syndrome, DIC, renal failure, cerebro vascular accident and induced cardiopathy.
lists placental abruption as a dangerous risk of PE. It's my (limited) understanding that the same "stuff" that raises your blood pressure and makes you spill protein and damages your other organs can also cause placental abruption.

I did find some discussions about lovenox increasing abruption risk - and also one comment that it could decrease abruption risk in some women - but I couldn't find anything scientific to support either statement. I may have just put in the wrong search terms - if anyone else finds anything in Pubmed please post it! I didn't find *anything* that suggests that the lovenox could make your baby's heart stop beating. It's my understanding that about 25% of pregnancies end in the first trimester, and there's virtually nothing we can do about it.

Caryn has posted a lot of great articles about the paternal contributions in pre-eclampsia - your new partner may have contributed to your earlier-onset PE. It's also possible that getting older made your body more susceptible to the effects of PE.

As for declining lovenox this time around, that's definitely a long discussion you can have with your doctor. A few years ago, it seemed like many women around here were on lovenox, but lately it seems less common, so doctors may be thinking differently now. I found these links, but they may be out-of-date:
http://hyper.ahajournals.org/cgi/content/full/46/6/1252 - this article does say "meta-analysis of all case-control studies suggests that only FVL mutation is associated with an increased risk of preeclampsia." and "Recently, low–molecular weight heparin was shown to improve pregnancy outcome in women with a history of 1 fetal loss and a constitutional thrombophilic disorder."

http://www.preeclampsia.org/forum/viewtopic.php?t=34551 - this recent response from our Experts does not recommend underlying disorders testing after HELLP, but we do have many experts and they don't always agree.

http://www.preeclampsia.org/forum/viewtopic.php?t=20710 - this expert response about Factor V Leiden goes *completely* over my head, but I hope there's something helpful in there for you.

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Re : Would you do lovenox again?

Postby missdee » Tue Apr 21, 2009 08:47 am

I was on the heparin called clexane here. We started a bit late and therefore it didn't really help, but with my earlier pregnancy I was on aspirin and this time as well. I also have a blood clotting disorder. I have read that you could be "allergic" to your partners' sperm and that this could have an effect. But Caryn will probably know more about that. Maybe this is why you have the problems with your new partner? The man's tissue apparently takes a great part in forming the placenta. I have never read that the heparin could cause this. I'm very sorry for your losses. I've lost a baby as well and understand how you feel.

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Re : Would you do lovenox again?

Postby brianned5 » Mon Apr 20, 2009 05:49 pm

Hi Margaret, I have no experience with Lovenox, but I just wanted to tell you how sorry I am about the loss of your babies. I lost my daughter on 07/23/2008, I am pregnant with my second child and I am on baby aspirin and extra folic acid. I

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Would you do lovenox again?

Postby onthebrink » Mon Apr 20, 2009 03:34 pm

I have searched for questions related to lovenox and heparin, but I couldn't find anything that addressed my questions.

I had 2 pregnancies which resulted in healthy babies, though one was six weeks early. Years later, with a new partner, I got pregnant again and was induced at 35 weeks due to PE. When I got pregnant again a year later the doctor did some bloodwork and found that I had Factor V Leiden hetero. I was told I immediately needed to start heparin. I lost my daughter at 33 weeks due to PE and placental abruption. It has been nearly two years and we decided to try again. As soon as I got pregnant I was put on Lovenox, LDA, and extra folic acid. At 9 weeks we found that the baby's heart stopped beating somewhere around 8 weeks and I just had a d&c. I would like to try again but don't know what to do.

My question is this...I had three pregnancies that resulted in healthy children before I knew about the FVL and had no treatments for it. I then lost two babies while on a blood thinner. If I get pregnant again I am scared to death to do the lovenox again. I have read that with hetero FVL it is really not necessary for the blood thinner and I wonder if it had any play in the abruption. I feel like if I was never tested for any underlying conditions things might have been different. Should I see a hematologist? I am already seeing a MFM and they are the ones that are treating me so aggressively. Has anybody decided against the blood thinners and what was the outcome, either way?

Thank you so much for your help.

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