TTC after Warfarin and DVT

[maggie75]

Hi - I am coming off warfarin after 6 months following a DVT and miscarriage. I have also had a DVT during a successful pregnancy.

Has anyone experience of TTC after warfarin therapy? How long did you leave it before TTC and were you put on Clexane (or other low molecular weight heparin) whilst TTC or only when you had conceived? I was on it only when I had my BFP last time and only a preventative dose - which clearly didnt work.

Any advice/experiences welcome. Advice and support from Haematologists pretty basic.

Ive heard of people on here and in RL mentioning units that merge Obs and gynae with Haemtology for women with DVT history etc - any knowledge of these (am in London).

thanks.

[BagofHolly]

Addenbrookes run a clinic jointly between obstetrics and haematology. The senior (and very lovely) haematologist, David Perry, has a special interest in issues in pregnancy. He mentioned that there was some belief that clexane can help trophoblast implantation which supports the protocols of some of the mc experts who prescribe clexane during ivf/ttc.
Could you ask to see a haematologist at your local hospital, or see would Dr. Perry advise you privately? He had developed a protocol for the management of women on clexane which had been adopted by the obstetrics dept, so there's a joined up approach. He was at UCH where I think they take a similar approach.

[pommedechocolat]

I take warfarin every day if I am not pregnant. When ttc I stay on it until get bfp then switch to clexane (once daily until 20 weeks then twice daily). I have to be careful to know when I am pregnant as if I don't switch before 6 weeks it can be very dangerous for the foetus.
This would suggest that there is no need to wait before ttc. It is however necessary to take clexane as soon as you get your bfp.

[maggie75]

Hi - thanks both for your messages. Interesting info about Dr David Perry, Ill try and do some searching if he does any private clinics. The Haematologist I saw yesterday was very uninterested about TTC and gave very vague info along the lines of its up to you, go to your GP and get clexane if you want and give it a go, not v useful. The dose I need obvs needs to be managed very closely and I need someoen to help me do this. Someone I saw before mentioned that they can scan the placenta throughout the pregnancy monitoring for clots and adjust the dose accordingly. Has anyone experience of this? I has lots of scans in my first pregnancy, but they were more for growth, as DD was small for dates - linked to concerns with clotting and also I have a subseptate uterus (heart shaped so can compromise growth).

[pommedechocolat]

Hi Maggie.
In my experience GPs are RUBBISH with ttc and anti coagulants. You need a haematologist. I have an amazing one but on South Coast so not much use to you.
My Haem told me that clexane on ttc is discouraged as long term use can be linked to osteoporosis and obviously you don't know how many months you'll be on it for before the 9 of pregnancy and the bit afterwards starts. This time on ttc I am on warfarin so no risk but last time was having a break to do more tests when I got pregnant so was on nothing until bfp and then clexane (the day of bfp onwards).
I had monthly scans through my pregnancy starting at 8 weeks to monitor growth and placenta. the monitoring of the placenta is monitored by checking blood flow 'waves'. Sorry - I seem to have forgotten this bit but they can measure blood flow 'pattern' into the placenta and if you get a nice even 'pattern' all good, any irregularities then the worry starts.
In terms of dose as I say last time I was on 40mg every 24 hours until 20 weeks then 40mg every 12 hours. That is standard as I had no issues on the monthly scans.
40mgs every 24 hours is the 'norm' for normal sized women so I imagine that's what you'd use if taking it when ttc...

[maggie75]

Hi - thanks for the placenta scanning info. In my first pregnancy I was on 60mg twice a day as it was treating a clot, but in the second (unsuccessful) one I was on only 40mg once a day as it was the prophylactic dose. They said Id need the higher dose if i were to TTC again, as 40mg still allowed 3 massive clots to form in my leg.

Ive another appt with a Haem on 2/8 in his (NHS) clinic, so am hoping for more time and a better info/care plan. He seemed to favour clexane whilst TTC, but am aware of the risks. Ive already taken it for a year - over various pregnancies/treatments. Noone can seem to quantify the risk of osteoporosis that is, how long is a long time on clexane and how much damage does this do to you. why is everyone soooo vague and non-commital. have a horrible feeling, they are all constantly actively avoiding potential litigation. rubbish when you actually want some aswers from these people.