W
waltsmom
I have had a lot of private email messages regarding pregnancy with heart issues. I have decided to post a message regarding my anticoagulation approach so those who are interested may be educated as to possible choices.
With my first pregnancy, I was on Coumadin for the first six weeks before realizing I was pregnant. At that point, I was placed on Heparin while I was waiting to be covered on Insurance. After another six weeks I was placed on Lovenox. For me these medications weren't monitored correctly and I developed a blood clot on my mechanical valve. One week following the delivery of my son, prematurely due to preeclampsia, I had open heart surgery and had my second mitral valve replacement. When I became pregnant this time, I discovered that there are quite a few women who have also experienced blood clots while on Lovenox with their mechanical Mitral Valves.
I don't tell you this to scare you, but to help you understand the risks involved with anticoagulation in pregnancy. I have changed my approach with this pregnancy and am secure in my decision.
I have been very blessed to make it with this pregnancy for 19 weeks so far. I decided with this pregnancy to take Lovenox for the first trimester and make the change back to Coumadin in the second trimester, then prior to delivery I will transfer back onto Lovenox. It may seem complicated, but I feel a big difference in my body on the Coumadin from the Lovenox. At 17 weeks I made the transition back onto Coumadin, I waited a couple weeks into the second trimester to make sure that the baby had developed all necessary organs in the first trimester.
I have talked with a Fetal Genetic Specialist and was advised that I have a 5% chance of anything happening with the baby because of Coumadin. The cartilage problems, which are more common in the first trimester, won't happen now as the baby's features have already been formed. But the risk to the baby is that she could possibly have some bleeding issues due to the Coumadin, and possibly the surface of the nose, which can be repaired.
If you make the decision to proceed with a pregnancy, and use Lovenox. Lovenox is a subcutaneous injected medication (shots). You would most likely have two shots a day, at the same times everyday. I chose 11 a.m. and 11 p.m. I set the alarm on my cell phone to go off at both times and this really benefited me greatly. There is a blood test, which needs to be done correctly to monitor the levels of Lovenox. This is called a antiXa or Factor 10. Which will measure the Trough and Peak Levels. The Trough Level is a blood test, which is taken one hour prior to your shot. The Peak Level, is a repeat of the same test four hours after you inject. This is to make sure you are correctly anticoagulated at your most critical points through the day. My Cardiac Research Specialist, through USC, who writes about this in great detail for the American Heart Association, informed me that it is crucial to be hospitalized for the transition from Coumadin to Lovenox.
The main thing I would like to relay is the difference in my body from the Lovenox to the Coumadin. Lovenox with long term use (and pregnancy is considered long term) can cause Osteoporosis. I would take Calcium supplements, however I felt pain in my skeletal form, my knees, wrists, and spine, were extremely painful. Almost immediately with the change back to Coumadin the pain has eased tremendously and the only pains I have are muscular back pain, and pain in my tailbone, which is common in pregnancy.
In most hospitals, their laboratories do not have same day results for the Factor X, this is the most important thing to work out prior to a pregnancy. A lot of facilities send out the blood and get the results back one week later. This is not an option, and some doctors aren't even informed about the importance of this blood test. I would refer to it as drunk driving. Make sure your hospital can do same day results. If they can't find one that can.
I had some issues at the hospital I had previously planned to deliver as they were not equipped to handle an anticoagulated delivery, or do the Factor X's same day. I am now being followed at UCLA and made the change only 10 days ago. If you choose to use my approach to the anticoagulation, be prepared for some controversy about Coumadin in pregnancy and uninformed doctors as to Mitral Valves and Anticoagulation in pregnancy. The approach I am using, is actually the standard protocol for Mitral Valves in Pregnancy in Europe, and will become the new protocol for the American Heart Association.
If you have any questions, my Research doctor, Uri Elkayam, M.D. has a wb site called valvesinpregnancy.info, where you can read the articles he has published and sign up for information. It might definitely be wise for you or your Cardiologist to consult with him prior to and throughout your pregnancy. I attribute my success so far to his research and expertise and close follow up on my case. I am very blessed to have this amazing doctor.
I hope this post is beneficial and those who are looking for options regarding pregnancy will realize there are choices to make and that we are the ones in control.
Sincerely,
Willow
--------------------------------------------------------------------------
January 1993 MV Repair
August 1993 MV Replacement (St. Jude)
September 1999 Delivered Healthy Preemie Boy
September 1999 MV Replacement (St. Jude)
December 29, 2006 Due Date - anticipating Healthy Girl
With my first pregnancy, I was on Coumadin for the first six weeks before realizing I was pregnant. At that point, I was placed on Heparin while I was waiting to be covered on Insurance. After another six weeks I was placed on Lovenox. For me these medications weren't monitored correctly and I developed a blood clot on my mechanical valve. One week following the delivery of my son, prematurely due to preeclampsia, I had open heart surgery and had my second mitral valve replacement. When I became pregnant this time, I discovered that there are quite a few women who have also experienced blood clots while on Lovenox with their mechanical Mitral Valves.
I don't tell you this to scare you, but to help you understand the risks involved with anticoagulation in pregnancy. I have changed my approach with this pregnancy and am secure in my decision.
I have been very blessed to make it with this pregnancy for 19 weeks so far. I decided with this pregnancy to take Lovenox for the first trimester and make the change back to Coumadin in the second trimester, then prior to delivery I will transfer back onto Lovenox. It may seem complicated, but I feel a big difference in my body on the Coumadin from the Lovenox. At 17 weeks I made the transition back onto Coumadin, I waited a couple weeks into the second trimester to make sure that the baby had developed all necessary organs in the first trimester.
I have talked with a Fetal Genetic Specialist and was advised that I have a 5% chance of anything happening with the baby because of Coumadin. The cartilage problems, which are more common in the first trimester, won't happen now as the baby's features have already been formed. But the risk to the baby is that she could possibly have some bleeding issues due to the Coumadin, and possibly the surface of the nose, which can be repaired.
If you make the decision to proceed with a pregnancy, and use Lovenox. Lovenox is a subcutaneous injected medication (shots). You would most likely have two shots a day, at the same times everyday. I chose 11 a.m. and 11 p.m. I set the alarm on my cell phone to go off at both times and this really benefited me greatly. There is a blood test, which needs to be done correctly to monitor the levels of Lovenox. This is called a antiXa or Factor 10. Which will measure the Trough and Peak Levels. The Trough Level is a blood test, which is taken one hour prior to your shot. The Peak Level, is a repeat of the same test four hours after you inject. This is to make sure you are correctly anticoagulated at your most critical points through the day. My Cardiac Research Specialist, through USC, who writes about this in great detail for the American Heart Association, informed me that it is crucial to be hospitalized for the transition from Coumadin to Lovenox.
The main thing I would like to relay is the difference in my body from the Lovenox to the Coumadin. Lovenox with long term use (and pregnancy is considered long term) can cause Osteoporosis. I would take Calcium supplements, however I felt pain in my skeletal form, my knees, wrists, and spine, were extremely painful. Almost immediately with the change back to Coumadin the pain has eased tremendously and the only pains I have are muscular back pain, and pain in my tailbone, which is common in pregnancy.
In most hospitals, their laboratories do not have same day results for the Factor X, this is the most important thing to work out prior to a pregnancy. A lot of facilities send out the blood and get the results back one week later. This is not an option, and some doctors aren't even informed about the importance of this blood test. I would refer to it as drunk driving. Make sure your hospital can do same day results. If they can't find one that can.
I had some issues at the hospital I had previously planned to deliver as they were not equipped to handle an anticoagulated delivery, or do the Factor X's same day. I am now being followed at UCLA and made the change only 10 days ago. If you choose to use my approach to the anticoagulation, be prepared for some controversy about Coumadin in pregnancy and uninformed doctors as to Mitral Valves and Anticoagulation in pregnancy. The approach I am using, is actually the standard protocol for Mitral Valves in Pregnancy in Europe, and will become the new protocol for the American Heart Association.
If you have any questions, my Research doctor, Uri Elkayam, M.D. has a wb site called valvesinpregnancy.info, where you can read the articles he has published and sign up for information. It might definitely be wise for you or your Cardiologist to consult with him prior to and throughout your pregnancy. I attribute my success so far to his research and expertise and close follow up on my case. I am very blessed to have this amazing doctor.
I hope this post is beneficial and those who are looking for options regarding pregnancy will realize there are choices to make and that we are the ones in control.
Sincerely,
Willow
--------------------------------------------------------------------------
January 1993 MV Repair
August 1993 MV Replacement (St. Jude)
September 1999 Delivered Healthy Preemie Boy
September 1999 MV Replacement (St. Jude)
December 29, 2006 Due Date - anticipating Healthy Girl
