Clexane for DVT & Use leading up to/during birth

[Chels]

Hi,

I'm very frustrated with my specialists' treatment of my pregnancy. My Vascular Sugeon and Obstetrician have differing views on what is best for my baby and I. I've been seeing a vascular surgeon because at about 6 weeks I developed a 'spontaneous' DVT in my shoulder. I took clexane 60mg twice a day until the DVT disappeared, around 20 weeks and since then I've been taking 40mg once a day as a precaution to prevent re-clotting during pregnancy. After an ultrasound on my shoulder revealed that they clot was gone, but damage was done to my vein, so that when I 'bear down' or exhale the vein closes and completly blocks off, my Obstetrician stated that it's too risky to push so I'll have to have a c-section. The risk with pushing being that a DVT could form as a result of the delivery (according to Vasc Surgeon). Obst explained that with a c-section there still is some risk with clotting at the wound site or in uterus, but this is apparently less a risk than a DVT forming if I push (and I'm sure there are many medico-legal reasons too). I was initally very upset because I was hoping to have as close to 'nautural' birth as possble, but over the last couple of months have come to terms with this believing that I am doing the best thing for my baby and I.
However, today I visited my Vascular Surgeon and informed him the obs plans of stopping clexane at 36 weeks in case I go into labour early. Reason being the risks associated with bleeding occuring at the site of the epidural. According to my Vasc Surgeon many anesthetists won't do a epidural within 12-24hours of taking clexane (again, medico-legal concerns), but he cannot see the reason for my obst's suggestion of ceasing cleaxane at 36 weeks when my obst has given no indication of any risk of early labour. (wow, this is getting long)
I've asked them both before to talk to each other about my treatment and when asking Vasc Surgeon (again) today if he would consult with Obst before my next Obst appointment this Wed he refused stating that I could just tell him! I'm paying these specialists a lot of money to take care of my baby and I and they can't even make a simple phone call to each other!!! :confused: I'm going back to have another scan on the shoulder at 36weeks to check on the condition of the vein and see if there are any improvements.

I would love to hear from anyone who has had/is having a similar experience with delivery and clexane.

I am currently 30weeks, so have 6 more weeks of clexane before being re-assessed after another scan of the vein.

[sarah81]

I have not been in your situation exactly. I have had a spotaneous DVT in my shoulder prior to having children. My arm has never been the same since! Very veiny but ok clinically.

As I have no pre-existing conditions - this has been checked 3 times now - I only have Clexane post delivery, it is started hours after the birth.

Which is no help to you really - sorry. I do have a friend who has had numerous pulmonary embolis and has clexane through out her pregnancy she stopped about a week before her induction. And delivered naturally.

Good luck with your appointment - I hope you get the answers you need.

[shinebrite]

Hi I might be able to help, I had a blood clot in my right lung (pulomanary embolism) when I was 30 wks and had 100ml of clexane a day from 30wks till 2 months post and then warfaren 2mths after that. Are u seeing a haemotologist? IMO the haemotologists were better than my OB in the fact they looked after me, I wasnt allowed to have an epidural because they couldnt cease injections in risk of another clot because of it in my lung, and c-section was going to b under general if any as c-section after having clexane is risk of hemmorage, have they told you that?

personally I would b a bit concerned about havin
a c-section because of hemmorage, and the fact ur partner cant be there under general... With the damage done to the vein, I spose thats a bit worrying they could put you on heprrin which is reversable incase u bleed too much after birth, while you are pushing (which is a drip) that way you can deliver natuarlly BUT u cant have an epi! thats what I did, they could also induce u like they did me so they can stop ur clexane for 24hrs then put u on the drip? they planned for me to deliver within 24hrs while being induced, it took 39hrs at 38 + 1/2wks so was put on the hepprin THEN told I couldnt have an epidural! not a pretty face! they told me i was allowed to have a epi on clexane but my OB was a wack job and when it came to delivery I didnt even see him! mayb u should change OBs?

dunno PM me if u want...hope that helps a bit

[lacejackson]

Hi there - I am taking clexane 60mg per day plus aspirin as I have thick blook and therefore am at risk of a clot.
I have a Hematologist who oversees this side of things and just liaises with my obstetrician. I have been advised also to go off the Clexane at 36 weeks in case I go into early labour. If you are definately having a C-section then won't this be planned and if so then perhaps you can just go off the clexane 24 -48 hours before this date as apparently that is all it takes for the clexane effects to discontinue.

Being on clexane my obstetrician and hematologist says that my chances of getting an epidural are next to nothing and that if I have a c-section then I will also need to go under general.

Anyway - hope this helps - it would be nice for you if your specialists could communicate between themselves!

[lovingmotheract]

i have to say that shinebrite i had the same as her but i had it after after bub was born with being on warfaren it takes 3day to get out of your blood and with heprrin if you have a hemmorage that can fix it better. i don't know about clexane how long that takes to get out of your blood but good luck and if you want tell your ob and Vascular Sugeon that you want to be put on heprrin and you want a nautural birth.

good luck and just say to your self it's my body and i will do it my way.

[InSaneOne]

ok this is gonna be long.

in 2001 i developed a dvt in my left leg. now the clot was in a vein and ran from my belly button to my ankle. (my leg swelled up and went a lovely shade of purple). in hospital they put me of heparin injections and a bit broke off the clot and went through my heart and into my lungs. one lung filled with blood and the other was half full before they managed to reverse it. i was on warfarin for 8 months due to that. then when i fell pregnant late 2004 i was told that due to the pe i had to go on blood thinners through my pregnancy and as warfarin was damaging to the baby they were going to put me on clexane. so i started daily clexane injections from week 7 to week 36. then they switched me over to heparin (because you can then have an epi or a c-section without the risk of bleeding out). i was on twice daily injections of heparin. i was told to cease injections when i started to get regular contractions so i stopped on sunday night (i would have been 40 weeks and 3 days) i then went into the hospital and was given an epidural at 3am on tuesday morning. beth was born at 10.17am tuesday (40 weeks and 5 days over). i noticed on wednesday morning that i was having crampy feelings in my left leg and on friday an ultrasound confirmed that i had a clot again. as the warfarin never properly stabilsed for me last time i opted to remain on the clexane injections for a further 8 months

i think that i developed the last clot due to the fact that i had an epidural and i was unable to move my legs without physical assistance for over 8 hours. (and stupid me forgot to pack my compression stockings) also another factor could have been the injection they give youto help with clotting after you have delivered the placenta. it wasn't discussed with me and i wasn't thinking that the injection could cause me to have another clot.

i have permanent vein damage in my left leg due to the original clot but in answer to the op's questions i was not told that pushing would cause me to get another clot.

if you want your 2 doctors to talk how about scheduling your antenatal appointment at the same time as you schedule one for your vascular appointment. then the drs will have no reason to use the excuses that they are busy with patients and don't have time to call. they should both have your history in front of them and then ask to conference call so you can hear the converstion too and raise any questions with both of them at the same time. if they refuse to do this find out why. if you aren't given an answer that satisfies you - you would be within your rights to ask for another dr - one that has your and your babies best interests at heart and not their own legal ones.

please pm me if you have further questions.

[Chels]

LaceJackson,
Thanks for sharing your situation.
I see you are on the Gold Coast too. Who's your Ob?
Vacsular Surgeon said exactly what you have-can't I just go off the clexane 24hrs before seeing as though no risk of prem labour. Will have to ask Ob tomorrow at my appointment.
Interesting that your specialists say no way for c-section and my ob says no way for 'natural' birth.
It is so confusing!

[lacejackson]

Hi CHELS
I am seeing Michael Flynn at Pindara - he is great!!!
How did your Ob appointment go?
I'm with you.... it's so confusing - esp when you get different stories from different specialists. Ask heaps of questions and hopefully they can come to some sort of consensus!!!!
Good luck - let me know how it goes.
Lacey

[brookeme]

Thought I would revive this thread cos its very relavant to my situation. I am really concerned after reading this, cos Ive had 2 emergency c/s under general anaesthetic, and a few of you guys have mentioned that an epidural is not an option on clexane, I am not on it yet, not p/g yet. As soon as I get a :bfp: I have to start. I was really really hoping for an epidural cos I had horrible generals with my 2.
VERY interested in how everyones going!! Please post and let me know!!!

:fingerscrossed:
Question??? Could my very obvious veins on my lower leg be a result of the clotting thing, i have had aching in that leg a lot.

[InSaneOne]

brooke

it is possible. don't mess around with blood clots - go and see a dr now. get an ultrasound on your legs if you are concerned and they aren't.

with the clexane it is one injection daily. they generally switch you over to heparin after 36 weeks. heparin is twice daily injections as it wears off faster than the clexane does.

[shinebrite]

Belinda~ I was on hepparin while I was in labour and they wouldnt TOUCH me with an epidural incase of being paralysed! Im sure every hospital has different regulations tho..weird PLEASE dont tell me and epidural IS possible I went through a 39 hour with NOTHING!!! :eek: but I think thats because I hadnt had an clexane injection for over 39hours as to which I had to have hepperin while I was in labour incase of a bloot clot I think thats why I dont know I was in LABOUR!


Brooke~ I know you are keen on havin a epidural but what you have to do you will do so mayb havin a drug free birth might be for you if this is the case? or do u have to have a c-section? If your having pains see your GP imedietly Blood clots travel! I had mine start in my calf and travel up to my lung in 3 days so its best not left alone.... HTH

[brookeme]

Thanks billieand beth and shinebrite! I was told that I would definately be having a planned c/s next time. Had no labour with #1, just emerg. c/s. Trial labour with #2, and another emerg. c/s, general anaes for both.
At least I have some idea whats going on now I am so glad that I read this thread cos I was totally in the dark, I have an appointment to see my doctor in about a week so I will definately be talking to her about all this!! The FS was the one who discovered the prob, expensive blood tests etc... I was so overwhelmed by it all, that I didnt really ask anything about it.
Thanks a lot guys!! :fingerscrossed: Wish me luck!

[InSaneOne]

shine - i was told to stop taking the injections on the friday when i had my checkup and i was 2 cm's dialated and 1 day overdue. so when they gave me an epi i hadn't had any heparin for over 72 hours. that combined with the epi i had lasting for 15 hours and not being able to move my legs myself probably resulted in my new clot.


but i was wondering... they also gave me that injection straight after the birth to deliver the placenta and to help stop the bleeding - would that have contributed to another clot? did anyone else have that injection while taking heparin or clexane?

[shinebrite]

i had the after birth injection and it didnt affect me...

[Chels]

I bled a lot during the c-section (I had a spinal and for this stopped clexane 3 days beforehand) and was given an injection, but was told that it was for the nausea I was experiencing as a result of my blood pressure dropping from the blood loss.

Am wondering if you ladies have all had leg clots? Is there anyone who had a subclavian DVT (in their arm)? I'm trying to find alternative treatment for what my specialist is recommending-taking out my first rib. NOT keen on the idea!

[shinebrite]

I think they all start in the leg? well thats kinda what I was told when I first had mine then they travel to the pelvis then arms lungs heart and then eventually the brain dont they? someone correct me if Im wrong tho... With everything get a second opinion if you dont want what they are suggesting but they do kinda know what they are talking about...IMO

[InSaneOne]

my first clot started in my leg and when i had it measured at the hospital it actually ran from my ankle to my bellybutton all up my left leg. it was incredibly painful (worse than childbirth) as all the blood could get into my leg but only a tiny bit was getting out again. my leg swelled up really big and was a lovely shade of purple. during the course of my treatment (they decided it was too big to operate) a big bit broke off went through my heart and into my lungs - when they realised 1 lung was full of blood and the other was 1/2 full. i had a long recovery time and i even had some minor liver damage from the clot. now 7 years on most of the clot has been resorbed but there is still a little bit from knee to mid thigh that has solidified. the drs think that will never go away but it doesn't cause me any pain. oh and it left me with more stretchies up and down my leg than i got on my belly after beth was born. and my left leg and calf are noticeably larger than my right leg - really sucks when buying jeans or knee high boots.

[nearly mum of number 1]

I am currently taking Cartia which is low dose Aspirin for a massive PE (lung clos) a few years back. My physician is someone that I have worked with in the past (I am in healthcare) and trust him very much. After he spoke to my Ob they agreed that in order to ensure that a PE does not reoccur I will need to inject Clexane up until and a short time after the birth. I would much rather do this than die

[Luna Lovegood]

At 5 month Pg, I was diagnosed with occlusive DVT’s in my common iliac to my common femoral. It was incredible painful, and traumatic. Was initially hospitalised for a week (I was unable to walk) and placed onto a Heparin Fusion drip, and discharged on 80mg/100ml Clexane (Low weight molecular Heparin) twice daily (12hours apart).

The initial plan was that at 36 weeks, depending on the stability of the DVT, I would be induced- my Clexane ceasing 12 hours before induction, being transferred on to a Heparin fusion- which is reversible. Then once in full labour, cease the heparin fusion (hopefully 6 hours prior to delivery), insert an epi 3 hours later- in case of c-sec. Once baby was delivered restart heparin fusion, pop me in a pair of air pump compression stockings, reintroduce Clexane 24hours later, and be Warfarinised 2 weeks later..

Now what really happened, was I was too unstable to be induced at 36 weeks, so they were hoping to just leave me till as late as possible. At 39 + 3 I went into labour, and was sedated to stop in progressing nay further, then 6 hours later- once the specialists where there, was induced.

The labour was traumatic- I couldn’t walk around much- I was strung up to drips, wearing a monitor around my tummy, a heart monitor, and my baby had a heart monitor as well. I did have an epi without risk, and did not end up having a c-sec BUT I was in labour for almost 2 days, and in the end I was in too much pain, and too tired to push and DD was delivered via Vacuum, which was brutal to see.

So in brief- Clexan was perfectly safe for me up until 12hours Delivery and I had an Epi, and delivered naturally- but with assistance…maybe you should get a second opinion, I found a lot of Doctors had varying opinions, and ended up having my bub at the Royal and my medical obstetrics dr's were brilliant, and very supportive. My Haematologist is at the Royal as well and was very supportive of my intended birth plan and delivery.

By the way- Have you been tested for Factor V Leiden?

[MooMum]

I had a DVT a few years ago and had to be on Clexane when pg with DS.

I have to clarify that Clexane IS heparin, is just a low weight molecular heparin, a different type that is a bit easier to predict medically. Sorry, I just think it's important that we know it's not a completely different drug.:ecomcity:


I stopped my Clexane 12+ hours before I was unexpectedly induced. Like the OP I was on 40mg daily which is not a huge dose, more of a prophylactic. I was able to have an epi also, by this time it was 24hrs post my last injection.

I had to have the Clexane 6wks postpartum also. This pg I only have to have it postpartum, last pg I flew OS long haul so they were being precautionary.

I hope the OP managed to get her Ob and Vas Surg to collaborate, Dr's don't realise how stressful this can all be.:no:

OP I don't think I've missed a post of yours having had bub, so please keep us informed as I am interested to see how you go. I wish you all the best and hope your birth is what you hope it to be. I do think though that as long as you and bub are both healthy and safe that is the best outcome, GOOD LUCK :hugs:

[Mrs Little]

Moomum-where abouts in WA are you?

I have been on clexane (80ml for bub #3 and 60ml for bub#2-both daily). Both were given right up to 24 hrs before labour was induced. Then as soon as bubs was born i was back on clexane that evening for another 3 weeks. I believe the clexane has a short life span- thats why you have to have it the same time everyday and daily.

I was also on Cartia (low dose asprin). I believe cartia has a longer life span in the blood supply. I was told to stop taking asprin 2 weeks before expected induction for bub#2, bub# 3 arrived unexpectdly so i stopped as soon a labour started.

I was on both meds to ensure that my blood was thin and no chance of clotting when passing through the umbilical cord to baby. I have a kidney condition that thickens my blood and only gets worse during pregnancy, so the meds ensure blood flow is ok to baby.

HTH.

Mrs Little & Sons.

[nearly mum of number 1]

It is ironic that you speak about Factor V because I saw my specialist yesterday and he gave me a blood form and told me to go and get these blood tests. One of them was Factor V Leiden. Can you tell me a bit about this? Do you have this?

Kirsty

By the way- Have you been tested for Factor V Leiden?[/quote]

[Luna Lovegood]

Facto V Leiden is a hypercoagulabitly disorder (blood clotting disorder) present in 4% of the Caucasian population- it is the most common.

There are two type- Hetrozygous and Homozygous.

Hetrozgous- Meaning one gene is mutated
Homozygous- Meaning two genes are mutated

With Factor V Leiden, 1 in 4 peole clot, and 30% of the people with DVT are Factor V Leiden.

The reason ladies clot with Factor V Leiden when they're pregnant is due to the extra estrogene (also dont take the pill or other estrogene contraceptives, mirena is the best option). Pregnant ladies with Factor V Leiden have a increased chance of:

Miscarriage
Stillbirth- as a result of blood clots in the placenta, umbilical cord or in the featus if the baby is postive for the disorder (50% chance)
Pre-eclampsia
Baby being born with low birth weight
When pregnant you may need a low weight molecular heparin.

Yes, I am positive for Factor V Leiden. Many woman have it and never suffer from it- for example, it is hereditory and many woman in my family have had successful pregancies. On the other hand, I got pregnant and clotted, then fell pregnant again and miscarried. I have four DVT's since being diagnosed wiht my first 16 months ago. The pain is horrible, and I hate living on Morphine. I now have liver damage from the amounts of different medications I take.

Hope that helps- if you need any information, I have many medical journals, and information (I work in a hospital, so I have access to a lot of good research material), just ask. :)