aspirin/heparin-when to stop?

[samoy]

Hi im currently 31 weeks. I have factor V so have been on fragmin/aspirin throughout. I was just wondering when everyone else stopped treatment or did you continue well past the birth? I have been told to stop aspirin at 34 weeks but continue fragmin up to 6 weeks post natally. Im just a bit weary
about stopping any of the treatment as it has worked miracles for me with this pregnancy..

Hi Samoy - I have Hughes Syndrome. I have one dd. When I fell pregnant I did one heparin once a day. At 20 weeks I added in aspirin and increased to 2 x heparin daily.
I had a planned induction and stopped aspirin the day before the induction. I missed one heparin injection during the birth itself (20 hours) and everything at the end was calculated to get me my injection (ie I had the epidural in for 6 hours post birth).
Post birth they told me to get back onto warfarin asap and do one week hep and warfarin before solely warfarin. I did a week just hep before this due to haze/bf struggles etc - was just easier to keep on hep.
Stopping pre birth sounds a bit odd to me as this is when the risk is bigger I would have thought? The risk of clotting is increased during pregnancy so being on meds until you are no longer pregnant seems the logical conclusion.

I was on Clexane for a previous post-natal DVT and was told to continue to 6 weeks post partum, which I did. AFAIK the first 10 days post natal is the biggest risk period, so I'd carry on if I were you.

I have APS/Hughes Syndrome too.

I have been on Asprin whilst TTC (I suspect as I had an early miscarriage even whilst on 2 x heparin daily) and also started one daily injection of heparin as soon as I got my BFP. I've been told I'll stay on the heparin until 6 weeks post birth, not sure about the asprin at the moment, seeing the haemotologist again on Monday.

I'm 32+5 with APS/Hughes syndrome - am on 75mg aspirin and 50mg clexane twice a day - have been told to miss one dose of clexane when I go into labour and to continue the aspirin until labour (as I have cerebral APS therefore the risk of stroke outweighs other risks).

They plan to induce me at 38 weeks (as I also have pre-existing diabetes) - so I wouldn't take the evening dose of clexane before induction - however I'm pressing for ELCS as I'm very concerned of the risk of stroke if I'm without clexane for longer than 12 hours and they can't guarantee I'd deliver within 12 hours even if induced. Plus they don't recommend induction via synotocinon drip if you're over the age of 35 like me.

You really need to talk to your haemotologist as how they deal with anticoagulation depends on the specific reasons for why you are taking it - i.e. someone who tends to have venous clotting is treated differently from someone who tends to have arterial clotting as the risks factors / potential outcomes are different.

Good luck

Please discuss with your haematologist asap.

You are at high risk of clotting until 6 weeks after delivery, so you shouldn't stop the clexane until at least then.

It is usual to stop the clexane for 12 - 24 hours when labour starts, but for those at very high risk heparin can be given as an IV infusion and the amount can be controlled/reduced. The haematologist, anaesthetist and obstetrician will discuss and agree on this.

Sorry you are getting weary - it is tedious, but you really need to get the right advice.

Good luck and hope all goes well.

3littlefrogs - I think weary is a typo for wary - I read it that way the first time, and then re-read. I think the OP doesn't want to stop her medication, but is being advised to do so (albeit only the asprin part).

Agreed Bramshott. Would also like to add to my above post - initial advice was heparin for 6 weeks post birth but then they decided that I should be back on my normal medication asap.

I have APLS too - I stop the heparin (clexane) 24 hours before c-section (38 weeks) & the aspirin 48 hours before (they check platelet levels the morning of section). Then start both again 12 hours after section for 6 weeks.

I would not be at all happy stopping anti-coagulants for such a long period before delivery - what monitoring do you get? I would want the advice of haematologist as well as frequent (every two weeks is what I get from 24 weeks onwards) scans (with dopplers) to check fetal growth & the blood flow through the placenta. I have had two mid-trimester losses & my experience has told me that you cannot be too cautious when it comes to clotting disorders & pregnancy :(

thanks all for your replies. Im really not happy stopping either medication so i will keep going i think. I dont seem to have had as much monitoring as some of you ladies-i dont have a haematologist to speak of- just blood tests every 6 weeks approx taken by my consultant. Maybe its because i have factor V and not Hughes? I was initially under st marys so i might call them regarding the aspirin.