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.
-H

 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.
-K


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.
-D

 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 it...so fingers crossed
-A

MTHFR:
 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.  

-W

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

 -J

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. 

-C

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.
-T