Clexane during pregnancy

[DDO]

Has anyone got any recent experience of using clexane during pregnancy? If so what dosage did you use? I have a history of DVT and self-injected 20mg daily during my first pregnancy - the consultant wants me to increase this to 40mg for my second pregnancy and I'm unsure as to why or what the benefits would be. Any help / advice much appreciated!!

[MrsBadger]

what were the consultant's reasons?
have you had a dvt since previous preg?

(I am thrombophilic but have never had a DVT so only do 20mg a day for 6wks postpartum)

[GothDetective]

I know p/n guidelines for clexane has recently changed. Women either used to get 20mg, 40mg or 60mg depending on weight. Now we give everyone 40mg. Though I suspect someone with a significant raised BMI would get 60mg.

[3littlefrogs]

Have you asked the consultant why?

[3littlefrogs]

40 mg is the standard dose in my hospital BTW.

[SoleLundyFastnet]

Hi DDO,

I injected 40mg of clexane per day from 4 - 32 weeks as part of fertility treatment due to recurrent miscarriage. Caused no problems (except some nosebleeds) and the pregnancy continued successfully. They did say I needed to stop at 32 weeks as I was having a planned section and they wouldn't be able to do a spinal anaesthetic if I was still taking the clexane.

Hope that is of some help

[DDO]

Hi - my new consultant thinks that 20mg is too low, even though I haven't had any further DVT's. I'm worried that an increased dose will affect bleeding during labour?

[reikizen]

You should have your levels regularly checked throughout preg and the dosage adjusted accordingly. We use tinzaparin so I'm afraid I don't know about doses for clexane.

[DDO]

Interesting that the guidelines have recently changed to use 40mg - is there anywhere I can access some info on this? Thanks!

[MrsBadger]

am trawling NICE but no joy yet - got a ref 3littlefrogs?

[3littlefrogs]

There are no NICE guidelines for use of clexane in pregnancy as yet. The work is still being done.

[Phoenix4725]

hi i was on 40mg of cleaxne for both dd and ds3.Think its becaus ethey know your prone to dvt taht they want to keep on top of.i had a Pulmonary embolism when pregnant with DD so when fell for ds it was staright on to it.

i had c sections with both dc and only had stop taking 48 hrs before hand and had no more than normal bleeding

[alypaly]

i believe there is an increased chance of a DT with the second pregnancy so the consultant may be erring on the side of caution. hope it goes ok

[3littlefrogs]

Also depends when you had your DVT and whether it was pregnancy related or provoked by some other cause, or unprovoked - ie: out of the blue. did you have thrombophilia screening after the DVT, or after your last pregnancy?

[rubyslippers]

i had to inject twice per day (20 mg) each time during this pregnancy as opposed to once per day with DS

i was told it was a new protocol (DD is now 12 weeks old)

i had no issues with bleeding in labour - actually much better labour than DS and no out of the ordinary blood loss - water birth

very likely you won't be able to have an epidural whislt on clexane so discuss your options with your consultant ...

[3littlefrogs]

There is a lot of work going on ATM to try to work out what is the best and safest way to treat/prevent clots during and related to pregnancy. It is mostly done by retrospective audit, because you cannot do randomised controlled trials on pregnant ladies due to ethical issues. Progress is good though, and there will be more information and guidelines coming through this year.

There will be some very exciting developments in the next 3 to 5 years.....

(waves back to rubyslippers)

[DDO]

Thanks for all the info 3littlefrogs (and others...). DVT was completely out of the blue and not pregnancy related, so i'm relatively low risk I think. Bit shocked to hear about people injecting TWICE a day...once was enough. I'm thinking I'll go with the latest advice and not take any risks though. Really reassuring to hear about a water birth too which I would love....thanks again, much appreciated.

[3littlefrogs]

No - out of the blue is not low risk. Unprovoked DVT (ie not caused by anything obvious such as hormones or surgery) is considered higher risk, and requires prevention strategies with anything known to be a risk factor in the future. Pregnancy is a risk factor. So, I think your consultant is being very sensible.

[DDO]

All makes sense 3lf thank you again....I've decided to go for the 40mg which isn't as frightening as it first seemed, and appears imminently sensible.

[Suze81]

I have been prescribed 20mg per day, which is for 'moderate risk' 40mg per day is 'high risk' I developed a DVT with my first pregnancy because I was diagnosed with pelvic instability and taped up so I couldn't move my pelvis. I then developed a DVT in my pelvis. This is 'Provoked DVT' which is what 3Lfrogs is referring to.
Personally I would like my dose to be increased to 40mg for my last trimester (which is when I developed the DVT last time, but the GP is unsure, because it all depends on whether you are considered high or moderate risk, which of course is a bit non-quantifyable. I'm glad your going with the 40mg, because if you just spontaneously developed a DVT, then thats high risk.

[grandmaofsix]

My Daughter was on Clexane during her pregnancy and was on 100 ml per day and is now on Clexane and Warfarin for a minimum of 6 weeks (Ellie was born 8 days ago)

[notso]

I had a P.E during my first pregnancy at 36 weeks I took a high dose of clexane until DD was born around 120mg IIRC then took warfarin for 6 months, I didn't have any abnormal bleeding after the birth.
With DS I had to take a prophylactic 40mg dose throughout the pregnancy and did have a big bleed shortly after delivering the placenta though the Midwife did say that it could have been due to him being on the large side.
Having to take 40mg again this time round, and hoping for less bleeding and a smaller baby!

[juisabella]

Hi All,

I have just been diagnosed with LUPUS, since our baby girl Isabella was stillborn 8 weeks ago. We are deeply sad and still in shock I think.
I have 3 healthy children 13,10 and 5 years old. I have had two mc's in the past.
I am 39 and have just been told at the 6 week check that now they have diagnosed me with Lupus I would have to have Claxane injections. I have to let them know as soon as I know that im pregnant. I am concerned as we dont want to lose another child. Also I am a true needle phobe!!. Does anyone know of the success rate of this medication?.
Im so worried about losing another child and having to put the whole family through the loss again. I love them all so much but my partner and I would dearly love to have a child together.
I hope this post makes sense to someone I am a little confused at the moment.

Ju

[Maame1812]

Hello all.
I'm just joining this forum. I had my son a year ago and developed a DVT post C-section. Was on warfarin for about 6 months and off it now
thinking of having a second baby and have been told I will need to be on clexane from start to 6 weeks post delivery
would appreciate advice on how safe this will be for the baby and I