Fragmin and Pregnancy

Off-Label Use of Fragmin During Pregnancy

In some cases, Fragmin is used "off-label" (for unapproved uses) in pregnant women. For instance, low-molecular-weight heparin medications (like Fragmin) are commonly used to treat clotting disorders such as Factor V Leiden in pregnant women. Fragmin is also frequently used to prevent miscarriages in women with recurrent pregnancy loss, even if they do not have a clotting disorder. It is possible that Fragmin may someday be approved for such uses, although the cost of doing studies in pregnant women is often prohibitive.
Low-molecular-weight heparins (like Fragmin) are often used in combination with low-dose aspirin (81 mg daily) for preventing miscarriages. There are variations in exactly how Fragmin is recommended for this use. Some healthcare providers ask women to start taking the drug while trying to conceive, while others wait until near the end of the first trimester.
In most cases, however, the drug is started early in the first trimester. There is no standard recommended dosage. Some healthcare providers prefer to do blood tests (specifically antifactor Xa activity) to monitor the drug, although it is not yet clear if this is necessary or even helpful.

Using Fragmin During Labor and Delivery

Different healthcare providers have different approaches to using low-molecular-weight heparin medications near the end of pregnancy, particularly because there may be a risk of serious complications if epidural or spinal anesthesia is used in a person receiving a low-molecular-weight heparin drug. Some healthcare providers switch to regular heparin near the end of pregnancy, as heparin is a much shorter-acting drug.
Some healthcare providers prefer to plan an early induction of labor while keeping a woman on the low-molecular-weight heparin until a certain period of time before the induction. The exact period of time varies, depending on the healthcare provider's preferences and experience.
Alternatively, in some cases healthcare providers may choose to keep a pregnant woman on the low-molecular-weight heparin right up until natural (non-induced) labor. If she has a long labor, she may still have the option of epidural or spinal anesthesia. The exact length of time between the last dose of Fragmin and the earliest that epidural or spinal anesthesia can be given will vary from one anesthesiologist to the next (there are no "set in stone" recommendations). Some anesthesiologists are willing to give the anesthesia sooner than others.
In many cases, Fragmin will be restarted after the baby is born and continued for a period of time afterwards (six weeks appears to be typical), as the mother is at a high risk for clots after giving birth.
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Fragmin Medication Information

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