QuestionHi, I have had 3 previous pregnancy's and was given Lovenox, with an outcome of miscarriage, I have been reading up on some studies that indicate that Heparin had a higher outcome rate. I was given Lovenox due to my insurance would not cover heparin at the time. I just wondered if there was a big difference between the two, and if I should demand trying Heparin?
AnswerDear Amy,
Women with APS may have difficulties with pregnancy. During pregnancy, women are at higher risk of developing blood clots and preeclampsia. In APS, pregnancies are thought to be lost because blood clots form in the placenta and starve the baby of nutrition. Some women may have trouble getting pregnant, while others may experience repeated miscarriages. Blood clots that develop in the placenta can cause fetal growth problems, fetal distress, preterm birth, or pregnancy loss.
Expert care and close monitoring of the pregnancy is essential by a doctor knowledgeable about APS. Usually during pregnancy, physicians may recommend low doses of aspirin and daily injections of the blood thinning drug, heparin. This gives the fetus about an 80% chance of survival, a drastic improvement from the 1980's when fetal survival was around 20%. The therapy is started at the beginning of pregnancy and halted just before delivery to reduce the risk of bleeding during childbirth. Soon after birth, the treatment resumes for about six weeks because of an increased risk for clotting in the postpartum period. In a more serious case preeclampsia may set in towards the end of pregnancy and a planned premature birth may be necessary. Heparin can cause bone loss, so women may need to take additional calcium during pregnancy. In addition, women need to be monitored for development of a low platelet count.
Since every pregnancy you have had has been treated with Lovenox and lost, it would seem reasonable to look to trying the heparin with a future pregnancy. It is a tried and true medication for this condition and I would think you could appeal the decision of your insurance company based on your medical history and heparin being the generally accepted treatment for APS pregnancies. It would be worth a try anyway! I have done some research, but cannot specifically find statistics regarding the effectiveness of heparin vs. Lovenox in treating pregnant APS patients - only that both can be and are used.
APS pregnancies are not normal. Normal pregnancy is 40 weeks. In APS, it is more common to deliver the baby between 30-35 weeks, and between 3-5 pounds. Heparin protects the placenta partially, but not fully so that the baby gets enough nutrition to survive longer in the mother. Once born, the babies typically do fine.
I hope this information has helped you and answered your question. I wish you well.
Brenda
