Clexane dosage - pregnancy

[Ladybee]

Hi

I have a history of miscarriage and was recently diagnosed with Factor V Leiden (heterozygous), I also have PCOS. I'm 6 weeks pregnant. My gynae consultant agreed to a treatment plan that would be 75mg aspirin and 40mg clexane once-a-day and this is what he prescribed. He referred me to an anticoag clinic for instruction on the use of clexane.
When I got the prescription filled, the pharmacist quizzed me about my status and history and attempted to call my consultant to confirm the prescription. She ended up speaking to a haemotologist consultant instead and my dr wasn't available.
The prescription was fulfilled and I started on the aspirin while I waited for my clexane initial appt, which was yesterday.
At the clexane appt, I was shown how to inject and then the practice nurse questioned the prescription. She said twice a day was more normal. She said she would check with haemotology consultant and call to let me know. She called later and told me to go to 2x a day 40mg, and has prescribed me more.

I am heavy, but have not had a clot before and have carried a pregnancy to term without problems. I am not sure whether I should be following the 2x day or 1 x day. I will try to get in touch in with my gynae consultant tomorrow, but I wondered whether there was anyone with any knowledge of the dosage guidelines for prevention of early miscarriage? I know it's probably not an approved use so perhaps dosage isn't established. I'm not at St Mary's but am in London and I get the impression that they don't deal with this situation a lot, probably because most London-based recurrent miscarriers end up being referred ot St Marys.

Any ideas anyone?

I have a different blood disorder but am on 75mg asprin and 1 x 60mg clexane a day. As far as I know one dose per day is normal, even if you have had clots in previous pregnancies (I had bi lateral pulmonary emboli in a previous pregnancy) but it may be different for factor V.

I was on 80mg clexane twice daily in pregnancy after I had the PE's and it is safe, so I wouldn't worry too much, just check as no point injecting twice daily if you don't need to!

The royal college of Obstetricians and gynaecologists recommends 40 mg twice daily.

The haematologist and pharmacist would be familiar with these guidelines, hence the discussion.

However - it depends why the gynae consultant prescribed it - for the prevention of miscarriage, or for the prevention of thrombosis.

This depends on whether you have had a previous miscarriage and/or a previous clot.

You really need to clarify this with your consultant, who should probably be discussing your case with his haematologist colleague.

I am on twice daily 20mg clexane injections. I have a history of recurrent miscarriage (7) but no blood disorders found. I am also on 20 mg prednisolone (steroid) and 400 mg progesterone. No aspirin for me though. I think it comes down to your consultant and what has worked in their experience. I have no knowledge what difference a blood disorder would have on the dosage.

Hope u get answers soon.

thanks - 3littlefrogs it was prescribed specifically for prevention of miscarriage, I've had 3 previous miscarriages but no previous clots, and when we found out the Factor V, he said that for prevention of clots he would only prescribe it if I was hospitalised and possible post-natally, but because of my MC history he agreed to using it throughout.

Getting hold of consultants never seems very easy, but will try to fax him today with the question so it doesn't get lost in translation via phone messages.

re: injecting twice daily, yes part of the reason I was worried about this is because I had an enormous bruise after my 1st try with the nurse, and thought if I had to suffer that 2x a day I'd very quickly run out of space! Fortunately the ones I've done myself have been bruise-free so that's not an issue. I just don't want to take more than I need to - equally, don't want to put myself or pregnancy at risk.

I was on 60 once a day but I had history of clots and placental failure. Bruising is a problem but I tended to do mine at top of leg as couldnt handle doing it in my belly.

It would be normal practice where I work for you to be referred to the haematologist, and for the haematologist and the obstetrician to manage your care together. The earlier the haematologist gets involved the better IMO.