Clexane injections, do I have to?

[troodiedoo]

I gave birth 3 days ago. Soon after the event in pops the midwife to announce that I have to inject myself with clexane for ten days as they have calculated that I'm an intermediate risk of blood clots.

I suspect they calculate this because I'm over 35 (37) and before pregnancy my bmi was 30.

Now I like to see stats to back up recommendations, and I can't find the study this was based on. Does anyone have a link or more details, or personal experience please? Ideally saying they didn't bother with them?

I'm also concerned they may be affecting my milk supply/production so would be interested to hear any thoughts on that

Thanks

I can't help with that, but I did have them ( c section) and it was fine. My DH did them for me. It was really straightforward and only hurt for a few seconds.

No idea on the stats or research, but I had to have them after my first born owing to a query on a blood test done after birth (I had a haemorrhage during/post delivery - can't quite remember!). Didn't have any impact on my milk supply that I'm aware of - he was a greedy little monkey anyway. The only thing I would say is to inject REALLY slowly, and not rub the injection site at all otherwise it stings like crazy!

Done it three times, no milk issues.

I think it is well established that post partum is prime time for blood clots but I don't have a reference.

There are two risks. A very tiny one that you'll react badly to it, and prolonged use seems to fuck your vitamin d and for some people increase osteoporosis risk. 10 days won't be a problem for the second one.

I would just do it if I were you. I didn't want to, and confessed to my midwife that I hadn't injected myself in a couple of days , she was horrified and told me that a woman 4 miles from me died from a blood clot leaving behind 5 kids 😥 . She even offered to come and inject me herself if I couldn't stomach it . For me it put it into perspective.
Congratulations on your new baby btw 💐

I don't understand why you wouldn't? Given you're a moderate risk? If it was clinically supported they wouldn't recommend it. Have you checked NICE guidelines?

As for milk supply, you're only at 3 days. It's not until around day 5 that your supply us usually established. It's perfectly normal and highly unlikely to be clexane related

I used clexane from being 2 weeks pregnant (ivf) all the way through and for 6 weeks after csection. I did have problems with my vitd levels being low but other than that it was okay. Don't rub or pull the injection out fast as it leaves a massive bruise mind you I was crap at doing it!

The drug notes say *enoxaparin in doses up to 40 mg daily do not to cause any adverse effects in breastfed infants. Because its large molecular weight of 2000 to 8000 daltons, enoxaparin would not be expected to be excreted into breastmilk or to be absorbed from breastmilk by the infant. No special precautions are required

Also when it comes to your baby's vaccinations, you can look them straight in the eye and tell them what's sauce for the goose is sauce for the gander.

I had them after my section. I'd already been injecting myself with other things for ivf so I just got on with it.

Read the NICE guidelines.
They are the reason that pulmonary embolism is no longer the leading cause of death in England.
The guidelines are based on over 20 years of studies and research. Probably more, but in the last 20 years the structure and documentation of clinical research has improved enormously.

It is 10 days of slight discomfort to remove your risk of sudden death.
It is worth it.
You can also google the Green top obstetric guidelines that explain the rationale behind the risk factors.

I had to do them after an EMCS a few weeks ago. It wasn't pleasant but once I worked out where I was numb after the c section my husband could inject me and it didn't bother me.
There's no pain from the injection to be honest, and only a tiny sting afterwards.

Better to do it than not and end up poorly. It's only 10 days 🙂

Sorry that should have said MATERNAL death.

The risk of blood clots is real and could lead to you having a pulmonary embolism or a stroke. No one is going to find you any research finding the answers you want because the evidence shows you are in an at risk group which is why you've been told to inject clexane for ten days.
You can choose to ignore the advice given and not inject yourself but you need to be aware of the very real risks.

I can't find the source now but I was looking up blood clots last night (after convincing myself that I had one ) and it seems there's a big drive to prevent them in the UK because they cause something like 25000 "extra" deaths a year!
The RCOG has a guideline called "Reducing the risk of venous thromboembolism during pregnancy and the puerperium" that should have to the relevant studies etc.

Cross post with endoftheline - the RCOG guideline is the greentop one

That's a good point outputgap I am very pro vaccines

I know I should suck it up. I know 2 women who have died from blood clots (not pregnancy or age or weight related though) I have done 3 already. I have a huge phobia of anything being near my belly button.

I just resent them thinking I'm lazy because I'm overweight. They also explained very patronisingly that I would have to do foot pumps exercises and be active even though "I wouldn't feel like it". I'd already started doing them. I'm a boxing coach and was in the gym 3 times a week till I was 30 weeks. After that got my 10000 steps most days.

Thanks all for making me see sense and perspective

I had them after my first daughter and honestly I didn't do the last couple of them as I hate needles. I kept my legs moving and the pressure stockings on for two weeks though.

Thought I would need them this time as well (high bmi) but no mention of them was made and I wasn't about to enquire about them!

Oh, you can inject into your upper thigh instead. Don't need to pinch an inch or anything. Just whack it in and think how double hard you are!

Oh, you can inject into your upper thigh instead. Don't need to pinch an inch or anything. Just whack it in and think how double hard you are!

My now late DM had her leg amputated due to a blood clot. Please, please don't put yourself through that if you don't have to.

𝐜𝐨𝐧𝐠𝐫𝐚𝐭𝐮𝐥𝐚𝐭𝐢𝐨𝐧𝐬congtratulations btw

Everyone who has a c.section has to have cleaxane, nothing to do with them thinking you're lazy!!

Hi OP
www.nice.org.uk/guidance/cg92/evidence/full-guideline-243920125
link to the evidence base for NICE guidance. Info re postpartum VTE from page 428.
Your call but I would do it. I'm a hospital pharmacist and used to work on a VTE committee in my hospital so have some knowledge in this area

I didn't have a c section, had 3 pessaries to induce and then vaginal delivery no pain relief.

Can you really do it in your leg? I'll be fine with that. I'd still like to see numbers but I'll stop obsessing over them now and go and stab myself.

Thanks for the congrats

I had to inject clexane daily from 12w of pregnancy until 6w post delivery for a more specific risk of blood clots due to a pre-existing condition. I got used to doing it but am a total wimp It's not fun but better than the potential alternative! I definetly recomend upper thigh. Is there someone else such as DP who could do it for you? The anticipation of 'forcing' yourself to do this is some times worse that the sting!

I inject dalteparin (same family of drugs) and have done twice daily for over 2 and a half years, you can inject in upper arms (wouldn't be my recommendation..Only the nurses when I'd had open abdominal surgery did that, big bruises) love handles, thighs, belly. I do love handles day to day, thighs if I run out of space (bruises and haematomas). It's 10 days, they are potentially life saving drugs and if you got a clot you'd be doing them a lot longer to dissolve it and at higher doses with potential for more side effects. Congratulations