Lovenox and Pregnancy

Off-Label Use of Lovenox During Pregnancy

In many cases, Lovenox is used "off-label" (for unapproved uses) in pregnant women. For instance, it is commonly used to treat clotting disorders such as Factor V Leiden in pregnant women. Lovenox is also frequently used to prevent miscarriages in women with recurrent pregnancy loss, whether or not they have an established clotting disorder. It is possible that Lovenox may someday be approved for such uses, although the cost of doing studies in pregnant women is often prohibitive.
Lovenox is often used in combination with low-dose aspirin (81 mg daily) for preventing miscarriages. There are variations in exactly how Lovenox 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. Most commonly, however, the drug is started early in the first trimester.
There is no standard recommended dosage, although a Lovenox dosage of 30 mg to 60 mg once daily is sometimes used (often with a dose increase in the second trimester). Some healthcare providers prefer to do blood tests (specifically anti-factor Xa activity) to monitor the drug, although it is not yet clear if this is necessary or even helpful at all.

Lovenox and Labor and Delivery

Different healthcare providers have different approaches to using Lovenox 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 Lovenox. Some healthcare providers switch their patients to regular heparin near the end of pregnancy, as heparin is a much shorter-acting drug.
Also, there is a fast and easy blood test that can accurately show how anticoagulated a person's blood is with heparin (the same is not true for Lovenox). Lovenox is a much longer-acting drug and there is no medication to counteract its effects.
Some healthcare providers prefer to plan an early induction of labor while keeping a woman on Lovenox until a certain period of time before the induction. The exact period of time varies, depending on the healthcare provider, although it appears that stopping the drug 24 hours before the induction is fairly standard.
Alternatively, in some cases healthcare providers may choose to keep a pregnant woman on Lovenox right up until 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 Lovenox 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. Of course, even with other plans, this situation (in which Lovenox has been taken right up until labor) will occur occasionally. For instance, this would happen if a woman goes into labor prematurely.
In many cases, Lovenox 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 developing clots after giving birth.
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