Clexane for Hughes- when to come off?

[squizita]

I have an appointment about when to come off clexane in a couple of weeks (have APS/Hughes). Previous appointment a 'baby doctor' (she described herself) said "ummm, when have you been told to come off it?" and wrote down 32-34 weeks (which is the usual window). Naturally I will seek a second opinion at my next appointment if they seem so unsure.

I have read various things, but just wondered when most people came off clexane (I think between 32 and 34 weeks?), and did they have any advice?

Mainly, warning signs to go to hospital and/or whether baby might come early!

I have APS. Both times I have continued clexane until 24 hours before my planned induction of labour (was able to get to due date both times as baby was doing well). Then six weeks post natal clexane. I also took aspirin which I stopped at 36 weeks. I was under the care of a joint obstetric and haemotology clinic who told me when to stop the medications. At the very least you should be seeing a consultant obstetrician. 32 weeks sound wrong unless you are expecting a premature delivery. If your growth scans are good then this would not be the case.

Kit I'm under Lesley Regan and Rag Rai at the national centre. The norm there does seem to be 34 weeks in everything I have read and briefings with the senior consultants? The junior would have been starting out in that specialist field.
I think I just got a junior covering that day.
They don't induce for APS at St Marys, so I guess cannot guess when the 24 hrs will be (their stats for success are the best - internationally - so this policy is not a concern for me in general).
However regardless of growth, APS babies do tend to come early which is why I think they switch at 34 weeks.
But 32 is very early.

I'm not a Lesley Regan fan for a start. I agree with the earlier posts about seeing a cons - both in obstetrics and haematology. Addenbrookes have a well developed joint departmental protocol which involves ideally planned induction so they can stop the clexane in time for an epidural, plus six weeks' post partum.
If you email the haematology department they should send it to you to have a look at. The lead Cons is Dr David Perry and he is quite the nicest and most thorough doctor I've ever met. (And there have been hundreds!)

In your shoes I would 100% ask for a second opinion and choose the most conservative approach.

I've done some reading up on it (I'm not switching hospitals 3rd trimester as up until this weird appointment it was all going so well - St Marys is also a joint dept - I've seen both type of consultants including Raj Rai several times... as mentioned, I think the issue here is an inexperienced 'locum' or trainee covering someone who would have known) and essentially across all hospitals there seem to be 2 protocols:
-If there is any danger of thrombosis or raised blood pressure for the mother, it's induction and clexane until then.
-If the antibodies purely affect the early formation of the placenta (as in my case) induction is not seen as risky and the protocol seems to be 34-36 weeks off clexane and natural birth (no recorded mortality for babies or mothers with this method provided there's no DVT, thrombosis or pre-eclampsia risk). Looking over my notes, this is the case with me: my blood pressure is fine, everything is fine, and my dose is the lowest for Clexane (slightly higher for aspirin).

Nowhere in any book does it say 32 weeks which makes me think this is a staffing/admin issue and I was sent to someone too junior that one time - I saw Mr Rai and saw admin staff getting a bit flustered as to who went to who... was I just sent to the wrong person?

I have since spoken to a RMC midwife who agreed with what my reading (of books not woo internet sites, I hasten to add) suggested and told me next time repeatedly insist on the team leader (i.e. Mr Rai).

...actually just emailed Mr Rai's secretary (my haemotologist consultant) outlining the problem, hopefully she will ensure that he doesn't let anyone inexperienced see me next appointment and/or fills me in in writing about what his recommendation is and why.

As mentioned, he's always been bang on with me and I am a bit dismayed I got fobbed off with what seemed to be his most junior/inexperienced assistant last time!

I wasn't suggesting you change hospital, I was suggesting you garner a second opinion and sight of an existing protocol.

What dose are you on? There's very little risk in staying on it compared to coming off with Hughes and given that the stakes are so high, I'd stick with it.

I had injections up to giving birth and for 8 weeks post natal. Was under OBs and haem consultants. Was told that if I felt I was going into labour not to take the injections that day. They metabolise in your system quite quickly; it's just you're not recommended to have an epidural within the 12 hour window due to risk of spinal haematoma.

Different for everyone I guess.