Clexane and Aspirin- not sure I want to take it

[helgaw99]

Hi
10 weeks pregnant with DC2.
Had booking in appt last week at Queen Charlottes. Midwife got me to see doctor at the same time. Doctor suggested I start taking aspirin and injecting clexane starting immediately until 6 weeks after birth.
When I asked why she said it's purely due to my high bmi- 40. I have no other risk factors, had easy pregnancy and birth time. Perfect bp, no protein in wee, was heavier then and no drugs were ever mentioned.
Doctor said I could think about it for a while as there was no rush.
I am inclined to take the aspirin but not the clexane as I'm not sure it's needed, if anything changes and I present more risk then of course I'll take it, but I just feel they are being too general in blanket prescribing it without taking into account history etc.
anyone have any thoughts or experiences?
Thanks

Hi Im currently 33+3 with a bmi of 44. I am taking daily aspirin but never been offered clexane, it's never even been mentioned.

Pulmonary embolism used to be the leading cause of maternal death in England.

It isn't any more as a result of loads of research, screening and prophylaxis.

Risk assessment is now routine for all pregnant women.

You have a degree of risk. This will be monitored during your pregnancy and, as you and the doctor have agreed, your risk will be re-evaluated as your pregnancy progresses.

It hasn't been prescribed, it has been suggested, on the basis of known risk factors.

I am taking it for a clotting condition causing miscarriage. FWIW, it hasn't caused me any issues bar a couple of bruises when I injected myself clumsily getting the hang of it!

It is very safe to take during pregnancy if that is your concern?

I had a BMI of over 40 in my last pregnancy and a history of DVT. I was given neither asprin or Clexane during the pregnancy, but had to have injections after the birth - for six weeks if I remember rightly.

As long as it wasn't harmful to the baby, I would inject it during pregnancy. I'm yet to have that conversation with the midwife/consultant in this pregnancy.

It's really not an issue. I have a clotting history, so am on heparin (Fragmin) daily. Sometimes the injections hurt, sometimes they don't, sometimes they bruise, sometimes they don't, but it's fairly harmless. It doesn't cross into the baby. For me it's better than the alternative.

I have a high bmi 42 and I'm on aspirin daily but I also have family history and factor v lieden so celexain was mentioned but only if I was bed rest and for 1 week after birth, I've had them b4 but only for a few days and they really hurt! So was glad when consultant told me that

How long is it since your last pregnancy? Possibly you have passed one of those invisible age barriers in the literature that says your risk of DVT etc has increased, and this combined with the BMI now makes Clexane indicated. (The advice on something changed for me between spring and summer in one pregnancy when I hit 37 for similar bizarre reason).

Clexane does not cross the placenta and so is no risk to the baby. If it is being suggested, it is to protect you from getting a blood clot or high BP in pregnancy.

Cons: Injecting every day is a bit of a pain & you get bruises. Also long term Clexane use is associated with a decline in bone density- ie taking it for several years at a pop- taking it in one pregnancy is not that bad but there is a slight decline- studies have shown that taking it for a pregnancy is associated with approx 3% reduction in bone density in the spine and 1% in the femur (but bear in mind that breastfeeding a baby reduces it by a roughly similar amount). If you take it you can get a high concentration calcium and vit D tablet prescribed to help offset this.

Pros: significant reduction in the chance of a blot clot and pre-eclampsia. The highest risk group for getting pre-eclampsia (high BMI, maternal age and a previous history of getting it in a previous PG, for example, it will reduce the risk of getting it again from 30% to 5%) I know you have no history of it before, but suspect your risk is presenting slightly higher than in the last PG, hence the suggestion.

I'd get back to the doc and ask which factors have changed and why it is now indicated.