Stopping Lovenox at 18 weeks

mkille

1 Posts
Reply Posted on: Jul 11, 2017 at 8:01pm
Hi Dr. Braverman,

After receiving a MTHFR 677C homozygous test result I ended up at the Beer Center after conflicting opinions from other doctors on whether to take Lovenox or not. Beer center ran a gamut of tests. Everything came back fine with exception to hetero 4g PAI and elevated NK cells at 15.2%. They put me on Lovenox 60mg 2 times per day. I also did one round of 40g of IVIG last week. They are now stating they will have me only do this one month of lovenox (I'll be just shy of 18 weeks)and won't refill the prescription as it's just not their protocol to continue for a homozygous MTHFR diagnosis past 16 weeks generally. When I asked why they said this is because it's just not needed as PAI is only an issue in the first trimester and MTHFR doesn't necessitate being on Lovenox past 16 weeks. I am also on 1 baby aspirin daily which I have been on since the start of my IVF cycle and they said to continue throughout the pregnancy.

This is my 2nd pregnancy. The first sadly ended in a medical termination last year due to several Spina Bifida at 19 weeks. I have no prior history of clotting personally and no prior losses. Both babies were conceived via IVF due to make factor.

What is your protocol on this situation typically with respect to Lovenox? Im very afraid to come off of it so early. My concern is that a clot can happen at anytime in the pregnancy, even later on. Thank you for your help.

Dr. Braverman

2026 Posts
RE: Stopping Lovenox at 18 weeks Posted on: Jul 12, 2017 at 6:48am
I think you are focusing on clotting issues when they are rarely the problem. For the cases that I see here where we do a much more complete workup , I generally leave my patients on lovenox for the entire pregnancy and switch at 36 weeks to heparin.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.