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Lovenox, Heparin, and WTF.

What the hell am I supposed to take?During my endocrinologist appointment last week, I brought up that itchy, scratchy Lovenox rash to my OB/GYN, Dr. T.  And she wasn’t comfortable with how my body reacted.  

“That rash is from two weeks ago?  How does it feel now?”

“Less itchy, that’s for sure.  But it got all hivey and wouldn’t relax, not for about a week.  It itched like mad.”

“I don’t like that.  I don’t want you to continue to take Lovenox, especially if it gave you that reaction.  Who knows how bad the reaction could be the next time?  I want to switch you to something else.”  She started to write on my chart.  “Heparin could be another alternative for you.”

“Okay, what’s the difference?”

She told me that both Lovenox and Heparin are large-molecule drugs that don’t pass into the placenta, so Bsparl is safe, and also that they both serve the same purpose:  to protect me and my baby from blood clots (the risk of which increases with both Factor V and pregnancy).  

But you guys know how I am by now.  I feel weird taking extra drugs, and I’m very conservative about adding more and more Rxs to my daily routine.  Also, consulting with Dr. Google brings me all this scary information about how Heparin is a category C drug, meaning it could have effects on the baby.  I don't know what's what, but I do know that I need to trust my doctor and her years of experience over a Google search.  (Right now, I'm wondering if I can bypass these drugs altogether and just work out in the airplane bathroom for the whole flight.  Kidding.  Sort of.)

Yet I still find myeslf feeling uneasy, and looking to see if any of you have had personal experience with Heparin.  I'm very WTF about this and confused as can be.  Right now, I’m only on insulin, pre-natal vitamins, and blood pressure meds (don’t worry – safe for baby), but according to Dr. T, I’ll be taking something to help protect me from clots for six weeks after BSparl is born.  (Great.)  So now is a good time to figure out what works best for me.

Once again, I’m clueless about what to expect.  I’m sorry to keep pestering you guys with all these questions, but when it comes to anything other than insulin, I’m lost.  When I wrote about Lovenox before, you guys were invaluable and I learned a ton (even brought some of it up to my doctor).  Now I’m asking once more – has anyone ever taken Heparin?  Any weird, itchy side effects?  Any burning at the injection site?  Any … anything?  

(And BSparl says hi.  He just sent a messenger pigeon to me from the womb.  He is baking cookies in there.  Busy little peanut.)

Comments

A couple of interesting things that you may want to ask the doc about: I take fish oil to control cholesterol, etc., and one of the "warnings" on Drugs.com is that it can adversely affect clotting. This may or may not be sufficiently useful for you and BSparl. I also take horse chestnut for chronic venous insufficiency, and IT has a warning on drugs.com that it may adversely affect clotting. Then there's also the potential of Vitamin E to work against clotting (something that just showed up in the popular medical press this week).

The fish oil and/or vitamins may not be powerful enough for what you need, but they may be safer for BSparl than "drugs" per se. I don't know about the horse chestnut (how safe it is for pregnant women), and since it's not the world's best-known herb, I wouldn't begin to suggest looking at it without a doctor's OK.

I should also suggest (if you don't use them already) that you may want to look at adding compression hose to your routine. They are commonly used as one part of the approach to avoiding deep vein thrombosis on long air flights, and are said to help against developing varicose veins during the course of pregnancy.

Kerri, You CAN seek a second opinion on the subject of heparin. Remember, that Baxter's heparin large-molecule drug wasn't all that long ago implicated with all kinds of contamination problems from the source China (which produces more pigs than any other country on earth, a source material used in heparin), so you have a right to be concerned. As President Reagan and Mikhail Gorbachev once famously stated "Trust [meaning your doctor], but verify."

Hello Kerri

I'm not in a position at all to offer you advice as I an not an expert on anti-coagulants in pregnancy and have no personal experience. I also don't know all the background information.

I do know that enoxaparin is Clexane in the UK. And I also know that usually heparin is more difficult to administister (because ita shorter half life so needs to be given more often).

It sounds like you have a good doctor who will answer all your questions.

Best wishes,
AM

Heparin is used as a fertility treatment for clotting disorders - it helps a lot of women stay pregnant.

Kerri, I'm pretty sure that you are seeing a high-risk OB doc, so I assume that she wouldn't advise a Category C drug unless the benefits significantly outweigh the risks. Docs often use Category C drugs in pregnancy, and while there is some risk, most moms and babies do fine.

Tmana has some interesting suggestions, but be mindful that most natural medicines are also chemicals that affect your physiology--often in ways that are less well understood than something like Heparin. It was recently discovered, for example, that taking extra Vitamin E (beyond the amount in a healthy diet) actually increases risk of death.

Good luck on your flight!

I'd talk through the reasons for treatment with your obstetrician and the likely (estimated) risks of harm if you are not. You can then ask yourself if you think you are being over-treated or not ... (see this recent evaluation of obstetric practices) ...

Cleary-Goldman J, Bettes B, Robinson JN, Norwitz E, Schulkin J. Thrombophilia and the obstetric patient. Obstet Gynecol. 2007;110(3):669-674. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17766616 [Accessed November 3, 2009].  

... or whether looking for a second choice treatment is worthwhile.

I don't know about Heparin during pregnancy personally. During infertility treatments, though, I read a LOT of message boards and I know a lot of women took it during their pregnancy. So there's some anecdotals for you.

Sorry I can't be more helpful.

I do agree, however, with using compression hose if it's okay with your doctor. A fellow nurse blogger gave a glowing review to these socks in case you're interested: http://tinyurl.com/y9tb78j

I had daily heparin shots after surgery for about a week, and they left annoying bruises every time. Sorry, I don't have much more to add than that. Good luck!

I took Heparin the last roughly four weeks of each of my pregnancies because it doesn't stay in your system as long as the Lovenox and my doctors wanted to be able to control any bleeding if I went into labor before I was induced. The only adverse reactions I remember were the horrible bruises. Again, I took it at least twice a day every day (was taking it three times a day the last few weeks of my first pregnancy) in my legs or my tush. Also, I continued on blood thinner shots while also taking blood thinner pills so I was completely therapeutic before the docs took me completely off the shots. I think it was around the six week mark when I weaned off the pills. I can assure you from two personal experiences that dealing with blood thinners is much more fun than dealing with clots.

My wife has clotting problems in pregnancy due to antiphospholipid antibody syndrome. We had two terrible fetal deaths due to blood clots (28wks and 38wks). Fortunately we found an outstanding research OB. My wife took heparin injections every day of our three successful pregnancies. The kids are wonderful. My wife got bruises all over her belly but that is well worth it for our healthy three kids. Please don't try to second-guess your OB. If you have questions then getting a second opinion is a good idea - but get it from a real Dr, not Dr. Google. The internet has the information, but not the experience to ways the pros and cons of treatment regimens for your situation. Good luck!

I also did what I could to stay off as many medications as possible while pregnant - and my OB (a high risk OB) was very great and supportive of that. He did, however, talk of putting me on Heparin after seeing some of my family history - but decided that I wasn't really at risk for it so we didn't proceed that direction, but Heparin was the drug of choice on the table.

I did A LOT of Dr.Google research while pregnant too and I brought all my questions to my doctor about what I'd find. He was always very helpful in that area. I'd try asking your doctor about his opinion on the class C things.

I know nothing about Heparin, but know Dr. T. well. She definitely knows her stuff, but press her on anything you are worried about and ask her about whatever is suggested here.

wow, I am not familiar with Heparin. I hope the information your rec've helps you make a deicison. One thing I would suggest is get a second OP.

Ricki, another d-blogger, pumped heparin in a pump that looked exactly like a Cozmo side-by-side with her insulin pump. Maybe someone else can send you the link (typing on my phone here).

obviously i can't give medical advice, i'm not a doctor or nurse (yet :-), but i wonder if tmana might have an idea to talk to your doctors about. i'm sure fish oil isn't as strong as lovenox or heparin, but it does thin the blood. also i believe you can find low-mercury or mercury-free fish oil, though it might be more expensive.

i was talking 2-3 capsules of fish oil a day to keep my cholesterol in great shape, but i read higher doses can help with mood/depression, so i went up to 4-5. last week my endo warned me that could thin my blood, that it was probably ok but i should be aware of it and be careful about taking that much and aspirin at the same time. sure enough, i noticed 2 purple bruises on my stomach from shots, and a random bruise on my hand that i don't even remember bumping.

hi Kerri and B! if the heparin is for anti-clotting...what about pressurized stockings and arm sleeves?? because of my breast cancer, i use sleeves and stockings (Px) when i fly or sit for long on a trip...no meds. just a thought...

I gave myself 5000-8000 units of heparin twice a day for 2 out of 3 pregnancies. It was prescribed because of my extensive network of varicose veins and an EXCRUCIATING case of superficial venous thrombophlebitis. (Inflamed blood clot in a varicose vein). At the time, I happened to be pregnant with my future D child. I don't personally have diabetes. I did a lot of research, and in the end decided I couldn't risk a deep vein thrombosis, which can be fatal if it breaks off and ends up in a pelvic vessel. With the heparin shots, there was lots of bruising, and each shot felt different. I also wore custom, waist-high maternity compression hose, but apparently they're not as preventative as one would hope. Bear in mind I am not a doctor, and am recounting events from 8 years ago. I wish you all the best....

Hello there Kerri and BSparl. Kerri, don't know if I ever told you, but I'm a nursing student. During clinicals this semester, I'm at a cancer hospital. These patients take a myriad of drugs, so I have learned a lot, especially about anticoagulants since most are on some form or another of anticoagulant to prevent clots during and after surgery, as well as when they can't be as active being in the hospital. There's one that's used a lot and as far as I can tell, is relatively safe during pregnancy. It's a category B drug for use during pregnancy, meaning the liklihood of effects on BSparl are expected to be nothing. The drug is called ARIXTRA, also called fondaparinux. Might be something to look into or ask your doc about. I would also like to second the PPs suggestion of compression stockings / trouser socks.
Good luck, and let me know if I can help with medical research in any way. I'm a nerd, so I like random medical stuff.

I'm only a 22 year old (almost) college grad so all I know is insulin, but I wanted to say that I get an absolute KICK out of your Bsparl comments. Makes me giggle, that good giggle you don't get very often. :)

Don't know anything about heparin during pregnancy, but I took it daily for 30 days when I was sixteen and had no problems at all. No experience with injecting it directly, though--I had a PICC line and it just went through the IV.

Aren't you going to Florida? Why don't you just take a train? Or...maybe one of those smaller commuter airplanes that doesn't reach really high altitudes... of course, you'll have to detour around the capital ;). Still, maybe you have options other than meds. You could tell your boss that you need to not travel for a few months. That hardly seems irrational. The truth is, you could be on bedrest...then what would you do?

Big hugs. I don't take any of those meds so I have no great advice for you. :(
Take care, though!
Bethanne

Kerri,

I had to take heparin to treat a blood clot due to the fact that I had a picc line develop blood clot (picc line is like a semi-permanent IV, I had to use to get nutrition because I had severe hyperememsis) I remember the shots buring at the injection site but other than a little bruising, I didnt have any other side effects or problems.

Having worked in a hospital for years, it's my understanding that Heparin is a *very* fast-acting, but also short-lived anticoagulant. In hospital settings, it is almost always delivered by IV (commonly requiring a PICC line for extended use). I've never seen Heparin given as an at-home injectable treatment, although based on others' comments here, I guess it does happen.
When a patient needs anticoagulation at home, s/he is usually given Coumadin/Warfarin (which is probably contraindicated in pregnancy) or Lovenox. Lots of common drugs are anticoagulants, like Aspirin and Ibuprofen, but they too, are contraindicated during pregnancy.
There's some very sound advice in these posts regarding "alternative" DVT prophylaxis treatments. Compression garments are effective ... as long as one wears them. If you go this route, you don't want run-of-the-mill stockings from Target. Jobst is a reputable brand, and you'd need to go through your medical practitioner to acquire these. Also (please don't write this off as silly), plain old walking is the *best* non-medication means to prevent DVT/clots. Vein clots form when blood is temporarily stagnant (or "pooled"), most frequently in the calf or behind the knee. If you're on bedrest, or (worse) seated with your legs not elevated, without frequent walking, that's when dangerous clots will form. If you're working at a desk/PC a lot, your best bet will be to get up and walk very frequently. I know that will become more challenging as the pregnancy progresses, so your doctor will likely want to monitor you *very* closely during the last few weeks, regardless of what anticoagulant therapy you're on then.
Lastly, I can't say how potent fish oils are as anticoagulants ... but if your doctor had you taking Lovenox, then it's very unlikely that fish oil would be adequate. Lovenox is similar to Heparin on the molecular level, and is of similar potency.

Hope this is helpful. Best of luck with the pregnancy. No matter how decorated/experienced your doctor is, or how much you like him/her, it's always important to seek multiple doctors' opinions in high-risk or complicated situations.

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