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Discussion Starter · #1 ·
Hi. I would like to ask you some questions regarding Clexane and baby aspirin.

I am currently at 32weeks with twins pregnancy. This is my third attempt of ICSI after suffering a missed miscarriage. I did 2 blood tests 12weeks apart and found that I am positive for Lupus Anticoagulant Antibody and Anti Cardioolipin Antibody and diagnosed as having antiphospholipid syndrome.

I am on Clexane and baby aspirin at the moment. My consultant told me to have this treatment until I start to labour. However, I have researched internet and have mixed reports so I am confused and insecure. My consultant is a twins expert, but not haematology expert. My friend who is in a similar situation with a different consultant was told to come off the same medication at 34 weeks. Some people are told to switch from LMWH to normal heparin as their half life is shorter. Apparently, if the drugs are still in your body system, there is a risk when you have epidural or spinal anaesthetics. As twins pregnancy tends to have early delivery compare to singltons, I am worried any risk mentioned above. Some people have GA to avoid the risk, but I would like to see my babies born straightaway.

I am currently seeing the consultant every 4 weeks, so next one will be at 34 weeks. At the 30 weeks scan, both babies are growing at normal range.

Is there anyone on this board who is also on Clexane/Aspirin? If so, how are you advised by your consultant? After being off from the drugs, do you have close monitoring to identify IUGR or blood flow by colour Doppler?  Also, I found that after caesarean, some people were told to come back on Clexane to prevent DVT. My consultant has not mentioned this yet but has anyone told how long you will be after birth (eg 6 weeks)?

I would like to collate as much as info till next consultation. So any advice would be much appreciated. Thank you.
 

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Hi Macky,

In my case I have a clotting disorder (Factor V Leiden) and was told that I needed to be on the clexane throughout my pregnancy and for the 6 weeks postpartum. You only need to stop the clexane a minimum of 12 hours before an epidural is needed, so if you have a scheduled c-section, this is easier to control. As you say, some doctors switch to heparin nearer potential labour, but I had no issues just stopping it 12 hours before my c-section and resuming it immediately after the birth. I had a scheduled c-section at 37.5 weeks and had no signs of labour at that time. However, I had FVL and not antiphospholipid syndrome which may well be ok to stop at 34 weeks. Certainly you need to find out whether to continue the clexane/aspirin postpartum as this is a very high risk time for DVTs etc.

I really think you need advice from the people actually delivering your babies. Twins are higher risk and you need to be prepared obviously and it sounds like your consultant just is not on top of this. I think you need to request more guidance. I know that some people do stop the clexane/aspirin at 34 weeks as well and again, this needs to be clarified as it would be very bad to stop at the wrong time.

I think this really needs to be discussed asap as with twins, labour can start any time and it would be awful to have to be under GA for delivery.

I can see why you are confused as you need guidance from experts now.

Also, I really would query why you are not being scanned every 2 weeks with twins - I think this is standard for a high risk pregnancy which you have (twins plus clotting issues). I would find out about this asap as well for peace of mind.

Mich has given you some good links and I think you are absolutely right to ask these really important questions. Can you find out any more info. from the hospital about the team who will be overseeing your delivery etc?

Here is some info. which has info. about heparin/clexane and APS nearer the end.

http://bmc.ub.uni-potsdam.de/1477-7827-1-111/1477-7827-1-111.pdf

Wishing you the best of luck,

Daisy
x

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Discussion Starter · #4 ·
Mich10 - Many thanks for the links! I didn't expect any replies so thumbs up to you ^bow^

Daisy - wow, you deserve a PhD with that kind of knowledge! it's very assuring to see that you've gone thru a similar experience and got some great result! I went to hospital last friday without appo (at 32 weeks) to ask these questions but got knocked back by a chief midwife as the consultant was extremely busy (he is only there on friday morning). I voiced my concerns re:drugs then she made an appo next friday instead (at 33 weeks). So far, I have no sign of labour but frequently have braxton hicks and pray for no contraction by the next appo! My hospital deals with 80 twins per year and have a good NICU as well. But as high risk (37years old, ICSI, APS) even though this is a fraternal twins pregnancy, I feel that I need more care and reassurance instead of the usual 'you're fine' response.
 

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Macky,

I totally agree with what you say.  Unfortunately you really sometimes have to be your own advocate and not wait for the doctors to get their act together.  Shout for what you want and continue to shout.  You are a high risk pg and need special attention.  They need to have a birth plan sorted for you which takes into account your clotting disorder and your meds.

Have you written a birth plan and discsussed all eventualities with your consultant and midwife?  As I said, start shouting now.  Mention the contractions (even if they are Braxton Hicks, early contractions with twins are significant).  I had contractions/BH at 28 weeks and was immediately admitted for 2 days to be monitored.

I cannot stress this enough.  You need to doorstep your consultant and demand that this be taken care of.  Remind them that you may go into labour at any time and what is their plan of action regarding the clexane and aspirin and your care.

I know I am going on and on!! But my experience is that sadly, you have to be the squeaky wheel sometimes in order to get the attention.  Also, forgive me as I know how easy it is for me to write this when you are the one who has to do the shouting, but I know you know what I mean as you sound rightly concerned in your posts.

Who diagnosed your APS?  Is that an avenue for information or influence with the docs. at all?

Anyway, let me know if there's anything constructive I can help with.  I was lucky to be under the care of St. Mary's recurrent miscarriage clinic and their care continued for my antenatal and postnatal treatment.  I had fortnightly scans and check ups which were vital in my opinion...

Good to know your hospital has twins experience and a good NICU, but you need some extra care and attention from the team!

Best wishes to you,

Daisy
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Discussion Starter · #6 ·
Daisy



Thank you so much for your post. You wrote what exactly I feel at the moment. To be honest with you, I was a bit reluctant to voice my concern before, as I am still under their care and did not want to damage the relationship with the consultant. The hospital is always busy and my assigned consultant of often away and I have not seen him for 10 weeks now. Last 2 consultations were with a registrar under the consultant and I found that he is not knowledgeable re: APS. So, this Friday, I will write down my concerns and make my point clear and hopefully have a productive discussion for my birth plan.



Re: Diagnosed APS.

On the day of the ERPC followed by ICSI, I demanded the hospital investigate the karyotype for my remaining of conception and do the blood clot panel as my father has a history of stroke/heart condition. A patient next to me in the ward requested the same thing but was turned down by the nurse and told “miscarriage is very common”. After she went to the theatre, I talked to the nurse and explained my situations i.e. how difficult it is for me to get pregnant and the cost involved for ICSI, my age, and emphasised that I need to know if the miscarriage is due to chromosome fault or not as this can help my future treatment. She brought an advisor in to talk to me. I told her that if the problem is cost, I don’t mind paying for it. Then she said that they have to send it to the lab and she is not sure if they can do it. She promised me to do her best and disappeared. Just before I went to the theatre, she came back to me and said they can do the test for me. But for the blood test, I need to have at least three miscarriages to justify the test. She told me to call the ward 6 weeks later to find the result. However, every time I called the answer was they don’t know the result yet.



We have decided to do the last ICSI abroad. Before the treatment, I asked them to do the blood test too. Then, I have discovered that I have LAC, ACL, and slightly higher ANA. At that time I could not do ET due to OHSS so froze the embies and waited until I fully recovered. 12 weeks later, I had the same blood test as one test is not enough to diagnose APS. Then again, the result was positive and even higher! I realised that I needed to get LMWH treatment, but my GP could not help and found that St Mary’s waitlist is for a year and I had to do contraception before they see me which was unbearable for me.



I was stuck for the prescription of Clexane. Then we went to Dr. *******’s clinic in Harley st. It was not cheap to see him but there was no choice for us. He chased up for our karyotype test as he knows people at the lab. They said that they could not culture it so the result was incomplete. At least we know what’s going on. He did another test including NK cells. NK cells were fine but I definitely have APS, so he prescribed Clexane and baby aspirin and prednisolone if I want. As prednisolone was not a must have item, I decided not to do it as I was not comfortable with it. He instructed me to start baby aspirin one month before ET and Clexane 2 days after EC. I know that St. Mary has researched re: aspirin which they believe to prevent implantation. It was a dilemma as this field is still new and has not established a definitive treatment and different Dr. said different things! 



Luckily, I got pregnant and my HCG at D14 was over 200 so I was relieved. I went to GP and showed all my medical report Re: APS. He referred me to the consultant immediately and I finally managed to get prescription by NHS. Dr. ******* suggested us to see him privately after but we have decided to be seen by our local hospital. I was glad to be proactive to get what I needed but it drains me out completely to have to deal with many people who seem to have their own opinion. I have researched my condition and treatment but at the end of the day I am not a medical expert and this field is still a mystery area.



Sorry for the long story. 

Macky
 

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Hi Mackay,

I was on clexane and aspirin during my pregnancy and had a scheduled c-section at 38 weeks.

I was adised to stop the aspirin around 36-37 weeks, at least a week before delivery.  I expected to have to stop the clexane before but the hosp give everyone a clexane injection the night before anyway so I carried on right up to delivery and I had not problems with bleeding.

I aslo carried on with clexane for 6 weeks after delivery.

I also insisted on seeing the consultant as I found different doctors had different ideas about when to stop meds etc.

Good luck

Tracy x
 
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