When do you start Lovenox?

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jenndola
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Re: When do you start Lovenox?

Postby jenndola » Thu Jun 09, 2011 02:54 pm

Jean, I never actually had a c-section. With my HELLP pregnancy they induced me, and with my last 2 pregnancies I had preterm labor and premature rupture of membranes.

In my second successful pregnancy, however, they did refuse to give me an epidural, as I'd admistered my last Lovenox injection too recently and the risk of epidural hematoma was too great. I'm not ashamed to say I cried like a baby when they told me I couldn't have my epidural. ;)
So I have this silly thing called Antiphospholipid Syndrome, which led to a blood clot in my brain, a miscarriage at 14 weeks,
HELLP Syndrome at 19.5 weeks, and a miscarriage at 6 weeks.

Pregnancies 4 & 5 produced two sons. Hooray!
Big G, born at 31.5 weeks in 2005
Little G, born at 29 weeks in 2008

blythe
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Re: When do you start Lovenox?

Postby blythe » Thu Jun 09, 2011 12:57 am

I'm hesitant to add this bit to this thread because we started talking about simply using Lovenox and it slowly changed into addressing other issues around Lovenox - I'm a little OCD and I like to keep threads clean :-D. But rather than split the topic I'm just going to continue here because I think the issues around Lovenox are important and I have a direct reply to Jenndola -

Jenn, thank you again for sharing your experiences. I wonder a lot if we have a self-report bias on the boards and we're just not hearing from the women who tried an intervention and it didn't work. I think you've mentioned feeling bad about posting your story because everyone is always so hopeful that Lovenox will be the magic cure for them, and you feel bad taking away some of that hope. But you lost three babies and had HELLP while taking Lovenox and I think it's so important that we acknowledge that, both for you and for other women. I've always thought full informed consent was very important, even when there's bad news.

When searching for something else just now I found another mom who lost two babies on Lovenox. viewtopic.php?f=85&t=34551
Sadly, you are not alone.

Lovenox and blood thinners in pregnancy are still considered experimental by our experts. I don't want any woman to think her doctor is a bad doctor or that she could have had a healthy pregnancy if she had only been prescribed a certain drug. We have a lot of success stories on our boards and I absolutely cheer and celebrate every single one, but I also want to be clear that whatever worked for one woman may not be appropriate for another, and so far the best research says that a happy outcome is attributable much more to "subsequent pregnancy" and "luck" than anything a woman did or did not do.

I hope someday that I will be able to say something different - that "x" treatment really will help.

I think one of the hardest things about this disease is how little control we have.
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

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cmccaffrey
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Re: When do you start Lovenox?

Postby cmccaffrey » Wed Jun 08, 2011 06:42 pm

glad to help someone with my internet findings... i usually just end up finding trouble or finding crazy information to self diagnose myself with some outlandish disease! :D
Christa (25) & J (26)
Mommy to:
Mason born 10.11.10 @ 30+3 wks due to Severe Pre-E. Only lived 2.5 days
Noah born 2.1.12 @ 38 weeks thanks to lots of doctors visits, LDA, Lovenox and no preeclampsia!

learn more about our story... http://tinyurl.com/7a979vy

blythe
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Re: When do you start Lovenox?

Postby blythe » Wed Jun 08, 2011 05:45 pm

You may absolutely share and it was a good find! You saved me some time on pubmed :).
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

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cmccaffrey
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Re: When do you start Lovenox?

Postby cmccaffrey » Wed Jun 08, 2011 05:19 pm

I didn't find much else. I realized it's not an exact fit, just thought I would share.
Christa (25) & J (26)
Mommy to:
Mason born 10.11.10 @ 30+3 wks due to Severe Pre-E. Only lived 2.5 days
Noah born 2.1.12 @ 38 weeks thanks to lots of doctors visits, LDA, Lovenox and no preeclampsia!

learn more about our story... http://tinyurl.com/7a979vy

blythe
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Re: When do you start Lovenox?

Postby blythe » Wed Jun 08, 2011 04:15 pm

Very interesting study! I'm not sure if it applies to our population though - they studied women who had an abruption in their first pregnancy and specifically women who did not experience fetal loss, no mention of preeclampsia in the women selected. PE is listed as an outcome measure, so I assume from the abstract that the treatment did not *increase* the rate of PE in their study. Any other sciencey gals want to take a look? It's been a while since graduate school for me but after almost 8 years of reading PE related studies I'm pretty cautious about the generalizability of what I find.
Heather, mom to
#1 7-18-03 - 5#8oz 37 weeks PE/PIH
#2 8-11-06 - 6#14oz 37 weeks PE/PIH
#3 9-10-09 - 5#10oz 37 weeks PE/PIH

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cmccaffrey
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Re: When do you start Lovenox?

Postby cmccaffrey » Wed Jun 08, 2011 03:31 pm

Jean, I was actually looking into that myself... I did find this...

http://www.ncbi.nlm.nih.gov/pubmed/20694277

"Administration of heparin in the secondary prevention of placental vascular complications is still experimental. In women with a previous placental abruption, we investigated the effectiveness of enoxaparin, a low-molecular-weight heparin, in preventing these complications. Between January 2000 and January 2009, 160 women from the NOHA First cohort, with previous abruptio placentae but no foetal loss during their first pregnancy and negative for antiphospholipid antibodies, were randomised to either a prophylactic daily dose of enoxaparin starting from the positive pregnancy test (n=80), or no enoxaparin (n=80). The primary outcome was a composite of at least one of the following: abruptio placentae, preeclampsia, birthweight < 5th percentile, or foetal loss after 20 weeks. Enoxaparin was associated with a lower frequency of primary outcome: 12.5% (n=10/80) vs. 31.3 % (25/80), p=0.004, adjusted hazard ratio = 0.37, 95% confidence interval (0.18-0.77), p=0.011. Enoxaparin was safe, with no obvious side-effect, no thrombocytopenia nor major bleeding event excess. This pilot study shows that enoxaparin given early during the second pregnancy decreases the occurrence of placental vascular complications in women with a previous placental abruption during their first pregnancy."
Christa (25) & J (26)
Mommy to:
Mason born 10.11.10 @ 30+3 wks due to Severe Pre-E. Only lived 2.5 days
Noah born 2.1.12 @ 38 weeks thanks to lots of doctors visits, LDA, Lovenox and no preeclampsia!

learn more about our story... http://tinyurl.com/7a979vy

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jean
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Re: When do you start Lovenox?

Postby jean » Wed Jun 08, 2011 03:10 pm

Does anyone know the stats of the possibility of abruption when using anticoagulants?
Our first son was born and passed in Feb of 2010. Born at 29 weeks due to HELLP and passed due to NEC. We miss him every day. :~(

Our second son was born at 39 weeks gestation in Nov of 2011. No HELLP or pre-e! Took LDA starting at week 12 and went off of it at week 38!

http://findingtherainbowconnection.blogspot.com/

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caryn
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Re: When do you start Lovenox?

Postby caryn » Wed Jun 08, 2011 02:40 pm

Researchers are *very* uncertain that there is any benefit at all from these medications in the vast majority of preeclamptics; Jenn's experimental med is much more likely to have affected her case given what it does and *her specific underlying conditions*! We may well just be seeing these meds scripped to women who weren't going to get it again anyway; most women do not get it again, and most who do develop it more mildly, later in pregnancy.

http://www.ncbi.nlm.nih.gov/pubmed/21262448 is a useful recent review; it says Furthermore, while data in women with prior severe pre-eclpamsia, abruption and small for gestational age births without thrombophilia suggests some promise for anticoagulant prophylaxis to prevent complications in subsequent pregnancies in these women, in the absence of large well done and generalisable "no intervention" controlled studies adopting anticoagulant prophylaxis to prevent these complications is premature. The absence of strong evidence, coupled with the small potential for harm from anticoagulant prophylaxis suggests that these drugs should be considered experimental in thrombophilic and non-thrombophilic women with prior placenta mediated pregnancy complications.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

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riehlism
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Re: When do you start Lovenox?

Postby riehlism » Wed Jun 08, 2011 02:22 pm

The medication seems to do a good job of keeping PE at bay, or decreasing the severity of the symptoms. Too bad that doesn't mean it's a guarantee. Darn!
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192


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