Opinions of Fragmin with no diagnosed problem?

[blue2014]

Had my 21 week consultant appointment today, due to age (37) and BMI (33) she wants me to take daily Fragmin injections from 28 weeks.

I've no personal history of blood disorders, stroke etc and my blood pressure is on the lower side of normal. No family history of this either.

I will do whatever is best for the baby, but it partly seems unnecessary (and I have a minor needle phobia but can overcome that)

Does anyone have a view on this they could share?

What were her reasonings? Have you any history of DVT/PE/Varicose veins?

You age and BMI combined will probably be the indication for Fragmin injections. During pregnancy you are more at risk of DVT and PE, being over 35 with a BMI over 30 are also risk factors. Two risk factors trust dependent is an indication for Fragmin.

No, no history of anything. Essentially her reasoning was that I'm old (37) and overweight

Daily injections prior to any monitoring seem a tad excessive though? Surely aspirin would be the first point of call? I think an evening of google scholar-ing the risks and benefits may be in order

Please no. This is not the forum to be taking medical advice from. Talk to your GP, consultant or midwife.

There isn't anything to monitor for a DVT. You won't know you are going to get one until its there.

And no, aspirin isn't the first point of call, that is for prevention of arterial clots not venous ones. Do you seriously think a consultant obstetrician doesn't know this?

I'm almost 11 weeks and was told by midwife at booking in I'd need to take fragmin from 12 weeks - I'm 37, bmi is 31, I had a previous section and I'm having twins! Seeing gp for a prescription on Monday so will see if they agree with the midwife.

Honestly, the consultant didn't tell me this, her student did in a 5 min appointment with no clear explanation (and no time for me to ask although they did say they would allow questions at the next appointment in 7 weeks I would like to be prepared)
I realise these are the limitations of the NHS with its time pressures, I have experience of both working in and conducting research in such settings and have experienced many a time people being provided with the recommended treatment in a 'one size fits all' model when actually a different treatment would have been more appropriate. I'm happy to take medical advice but I also won't do so blindly and without questioning whether it's the best thing.

I do appreciate the advice and guidance on this thread though, I'm grateful you've taken time to share opinions, knowledge and experiences with me.

VTE (pulmonary embolism) used to be the leading cause of maternal death in England.

Now that a proper screening tool has been devised and rolled out, this is no longer the case.

You have been risk assessed according to the RCOG and NICE guidelines and fit the criteria for thromboprophylaxis.

Of course you can refuse, or you can ask for a further appointment to discuss, or you could google the guidelines.

The current screening system took nearly 15 years to research and implement.

Aspirin is no use at all in prevention of venous thromboembolism.

Thank you frogs, that's helpful - I'm leaning towards having it, i just want to full consider it

Interesting, I have same risk factors and am having consultant led care but no-one has mentioned Fragmin/LMWH to me. May need to have a look at guidance. And I agree, you do need to be able to have explained to you why this is the best course of action so you can make in informed decision, irrespective of how busy the clinic is.

www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf
These are Royal college of Obstetrician Guidelines 2015.

www.nice.org.uk/guidance/qs22/chapter/quality-statement-8-risk-assessment-intermediate-risk-of-venous-thromboembolism

www.nice.org.uk/guidance/qs22/chapter/Quality-statement-9-Risk-assessment-high-risk-of-venous-thromboembolism

Both are NICE guidelines on assessment of risk of venous thromboembolism.
Hope these help you to have a bit more information.

I would agree with doing your own research, on 'proper' websites like NICE, RCOG, RCM and talk to people.

I have a higher BMI, and older and this has never been mentioned to me in 2 pregnancies. I have had recommendations made to me which go against NICE guidelines this time which I have subsequently done loads of research into and then discussed with consultants their reasoning for it to give them a chance to explain why they thought it was the best option and opted to not take the advice with backing from 3 midwives as well. Also if I was in my other two possible hospitals it would never have been offered, so was just a chance of picking the hospital I did.

I don't pretend to know more than the consultant but also will make sure I agree with what they are suggesting.

Thanks Mummydoc and Noodle, that's really helpful - I'lll research it all on Monday.
Thanks again

It seems to really be dependant on the hospital you're at. I'm on a plus size facebook group and a lot of us are on fragmin. My consultant was reluctant to put me on it though, despite having a high BMI, sister having a DVT, mother having DVT and PE and on Warfrin for life and being diagnosed with a blood clotting disorder that also causes miscarriage and still birth. My haematologist was clearly annoyed that I'd been put on them and had said I don't need them when I'd asked prior to trying to conceive (as my sister without the blood clotting disorder was put on them).

I also agree about doing your own research, I've come to not really trust doctors but when there's such variation between hospitals and individual doctors you really need to advocate for yourself. On the up side, there are not many risks to taking the fragmin so it may be worth the better safe than sorry approach. There will be bruising and it can increase chances of osteoporosis but you will be given calcium tablets. I've had no adverse affects from it. Saying that, you may want to look into giving birth on Fragmin because you need to have been off it for at least 12 hours before you can get an epidural or spinal. A lot of people are induced but no one mentioned this to me until recently (I'm 36 weeks now) so it may effect your birth plan if you have them.

Why would you consider the advice of people on MN over the the advice of a consultant. I understand that not being given a reason is frustrating but quite frankly if my consultant told me to stand on my head for 10 mins a 10 day to improve the chances of both mine and babys health during pregnancy, I would do it.

I'm also on Fragmin - known thrombophillia. It really isn't that bad. A few bruises now and then but that's it, you get used to the needles very quickly

Thank you Liss - I appreciate that.

Seeking - I think I already explained why I'm questioning this but honestly I can't understand why anyone wouldn't question their doctor. I've worked with consultant medics for many years, some are brilliant but some are awful - I'm not blindly accepting advice when if could well be from one of the not so great ones. It never hurts to question and find out more information.

I'm all for questioning the consultant - that's exactly what I was saying. Question the consultant rather than the users of MN. They wouldn't prescribe it for you unless there was a valid reason ( the health of you and baby). I'd be worried if they DIDN'T prescribe it. The last few weeks of pregnancy are the most dangerous when it comes to clots.
And I only said I'd do what ever the consultant said because having lost 4 pregnancies already - if indeed they said standing on my head would help, I'd do it!

I'm really sorry for your losses seeking while my experiences aren't at all comparable to you, one of the reasons I doubt consultants is because it took me 4 years and a round of private IVF to conceive this baby (primarily male factor). The advice I got from the NHS in this was contradictory and in the end, incorrect. I will do anything for this baby, but that involves me objectively questioning professionals (and already the advice on this thread has been useful, please don't think I will just accept what people on MN say but I'm using a variety of methods to inform my opinions)

Notably, it was mummydocs link to nice guidance which has shown me the IVF counts as another risk factor. The doctor never even mentioned this when I asked So MN does offer useful stuff.

I agree MN does have its uses for things like that but I do see a lot of people blindly ignoring the advice of medical professionals and I'd hate for anyone to experience loss because of it - especially when something like Fragmin has little to no side effects and is a relatively cheap drug. I do however think that clarification for things needs to be given more clearly within the NHS so that you can make an informed decision based on their 'expertise'. And time should be given for questions at all appointments to avoid people having to ask non-professionals.
Sorry you've had a battle to achieve this pregnancy, like you I've also had to fight and question the consultants along the way and have also ended up going private.
I can assure you that the needles don't hurt, inject in your leg over your tummy as it hurts less and expect a few bruises. You may be induced because of the Fragmin and will certainly need to take it for a period of time after the birth - my private consultant said 2 weeks for vaginal birth and 6 for CS. Good luck - I didn't mean to come across snotty

Thanks Seeking, you didn't come across snotty and I really appreciate your reply. It's honestly helpful and I imagine in the end I will take it so the advice on injecting is helpful too