Saturday, December 3, 2011

Results of Lovenox PC Survey

Thank you to all the ladies who responded to my question about lovenox preconception. I decided to collect all the answers in one place for my future reference and anyone else thinking about the same thing. I only used the first letter of someone's name to protect their privacy. I got some responses from my blog, the immunology yahoo forum and the MTHFR yahoo forum. There seems to be a lot of variation.

I am also wondering how much your weight makes a difference since some people mentioned weight. If I go by the 1mg per kg, then I should be taking 60 a day. My napro Dr does not want to increase my dose, he wants me to talk to my hematologist which is the responsible thing to do. It is just more of a pain bc I get monthly cbc but I do not see her, I go to the lab and then she just checks the results. Now I have to make an apt to speak with her,but the practice is huge with more than one Dr and it is a nightmare to call and try to get through to her office.

Then there is talk about a perinatologist which might be another avenue. I don't know what I want to do, I may just give my dose a few more tries and then decide.

Immunology Forum:
AEB has you start on CD6...30mg if you are under 140lbs and 40mg if you are over
140lbs...once a day until a positive pregrancy test and then twice a day with a
pregnancy thru 36 weeks. I hope this helps.

 Dr.B now had take 30 mg and start it on CD3. After taking it for 7 days he had a Heparin Anti-XA level drawn to make sure my dose was high enough.

I take 40 mg  once a day. It was the dose recommended by two RI's, my hematologist and OB. I have MTHFR, evidence of APA and history of miscarriage. Hope that helps. Oh and I started it around CD 5 but
Dr A was not strict on when I start. I requested I start it early, otherwise he would have me start on BFP.

 I am dx with APS, lupus anticoagulant. I have a history of m/c as well as a history of a blood clot. My hematologist believes in dosing lovenox at 1mg per kg. I am a bigger woman, 5' 11" and I weigh 236lbs, so my hematologist has me on 100mg of lovenox twice a day. When I was ttc, I only did one a day starting on cd6, but as soon as I got a BFP, I went to twice a day. My hematologist doesn't believe in doing Anti XA levels until the anatomy of my body begins to change due to the growing pregnancy. So I believe he won't adjust my dose until 20 weeks + and then he'll adjust based on my AntiXA essay. But for now, it's simply 1mg/kg. He does monthly CBC's on me to make sure my blood count is okay and that's it for now. I'm currently 14w6d. This is the farthest I've ever made fingers crossed

 I am homo MTHFR CT and take 40mg twice a day starting at my BFP.  My peri calls this a therapeutic dose (higher than a prophylactic dose).  I had my anti-factor Xa tested, and it was .64 - for a therapeutic dose, it should fall between .6 and 1.1.  Both my doctor and I are happy with it being on the low end, because I have no history of clots.  The MTHFR alone is not enough for most doctors to recommend 40mg twice a day, but my history of a (first pregnancy) stillbirth at 31 weeks, (second pregnancy) ectopic, (third pregnancy) placental abruption at 28 weeks, and (fourth pregnancy) miscarriage at 9 weeks indicates that I need a therapeutic rather than prophylactic (which would be 40 mg once a day) dose.
 I'd definitely get a second opinion through a pre-conception consult with a perinatologist or RE and have that doctor's recommendations sent to your doctor.  I did a pre-conception consult before my current pregnancy to outline everything that would be done and be sure I underwent all the tests recommended before ttc.  

40mg 1/day I know Dr. B would def. put you on lovenox 40mg 1/day.  that's what he did for me.

He can order an Anti Xa Test or Heparin Anti-Xa test that will show if you are taking enough.
I did not take Lovenox preconception, only starting at positive pg test. I have FVL and MTHFR both hetero. With one pregnancy I took 40mg/day Lovenox and did fine. With my next, I clotted at 9w in my leg on that dose. We did an Anti Xa test and it barely showed I was taking anything. Changed dose to 30mg/twice a day, Anti Xa test again, and result was not much different. My OB was also reluctant to increase my dose so I asked to see a perinatologist. Eventually, using the Anti Xa test, he got me up to 60mg/twice a day which put me at a low therapeutic level on the Lovenox. 

My Blog:

I started out at 40mgs 2 x day, and I was already taking it when I went to Dr K-K for that Doppler Uterine Biophysical Profile, which still revealed an elevated resistance index in the spiral and radial arteries. I then went to 60mgs 2 x day, which was subsequently decreased when my aPTT (pro-thrombin time, a blood test to see if your blood is clotting too slowly) was really long. I was decreased to 60mgs 1 x day.

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