Prophylactic Enoxaparin (Clexane)??

[BobandBenway]

I'm 37 wks pregnant with my 4th child, and at today's ante natal appointment the midwife mentioned that as I am at moderate risk of DVT (over 35 yrs and 4th baby) then I have to have enoxaparin (Clexane) injections for 5 days after birth.

I've never heard of this before, and I'm a bit confused. I've also been told that due to my age and 4th baby that I'm more at risk of PPH (though never had PPH with my other 3). I gather that clexane thins the blood to reduce the risk of clots forming, but won't this put me more at risk of a huge bleed?

Also, reading up on clexane, some sites say not to use it if breastfeeding?!

How great is the risk of DVT? I'm concerned that they've just ticked boxes and decided I need this. I'm not overweight, and it's never been mentioned to me before. Do I really need to take it? Would it be a huge risk if I didn't? I'm planning on breastfeeding and I'm also worried about potential effect on the baby, as well as putting myself at risk of a huge bleed. Help!

I am on a treatment dose of clexane this pregnancy (started on prophylactic dose and still got clots in my lungs). It's the second pregnancy I've been on a treatment dose and last pregnancy I was just on the prophylactic dose. Each time I've stopped it when going into labour then started again after delivery for 6 weeks/until 6 months after diagnosis of clots, whichever is longest. According to my haematogist the risk of a serious bleed on it is low, especially after delivery and it only has a short half life of around 4 hours.

You can breastfeed on it, confirmed by my haematologist and the breastfeeding network pharmacist. The molecules in it cannot get into breastmilk. I've breastfed on it twice, am still breastfeeding my toddler on it now and intend to breastfeed this baby while on it.

Thanks for your reply - that's reassuring re the breastfeeding.

I've been trying to do some digging to find out what exactly they define as "increased risk" - is it 2 x, 100 x ??? They hit you with this vague info, and all it does is panic you.

I keep being told that due to my age I'm more at risk of this, that and the other, but on the other hand, my doctor reassures me that "37 is not that old!". Then you throw in that this is my 4th child, and suddenly I'm beginning to regret having this baby! It has been one of the most stressful pregnancies wrt worrying!

Anyway, from what I've so far been able to decifer, the main risk factors of a venous thromboembolism are being obese, having a C section, previous history and smoking. It seems that the over 35 yrs risk is more related to the fact that you are more likely to be overweight / obese the older you are, but it's hard to see if that is really the determining factor. There is definitely an increased risk for >3 children, though still unclear (to me!) as to why that is.

Although I am a healthy weight (BMI 19), non-smoker and have low blood pressure, therefore I don't think I am at huge increased risk, it still worries me enough that I think it would be wise to take the prophylactic clexane.

One other thing I'm a bit confused about is that the RCOG recommends a 40mg dose for 7 days, but my health board recommends only for 5 days post-birth - why, and does the 2 days difference really matter?