She continued her heparin for 6 weeks. Once a target international normalized ratio of 2 to 3 is obtained, the heparin is discontinued. The vast majority of those with factor v leiden mutation will never have a clot, but the risk is increase during pregnancy, bed rest etc. The use of serial ultrasonography studies during early pregnancy have shown that the arterial signals in the yolk circulation disappear and the umbilicoplacental circulation increases between 8 and 10 weeks of gestation, indicating that the placenta replaces the yolk sac as an essential source of blood supply to the embryo at that time.1 Thus, it can be deduced that during the switch and at least from the beginning of the 11th week of gestation the maintenance of the permeability of the maternal placental intervillous space becomes a crucial necessity for the viability of the fetus. We included the 184 consecutive patients meeting our criteria. Copyright 2004 by The American Society of Hematology. Fetal complications such as miscarriage,7 intrauterine fetal demise (IUFD), placental abruption, and intrauterine growth retardation (IUGR)1 have also been associated with FVL. She was again encouraged to stop smoking, given miscarriage precautions, and told to follow up in 4 weeks. Because there are potentially serious effects of FVL for both the mother and the child, and because effective treatment strategies exist, early detection and treatment of this condition is warranted. Quere I, Perneger T, Zittoun J, et al. OR indicates crude odds ratio for giving birth to a live healthy baby after treatment with low-molecular-weight heparin enoxaparin, low-dose aspirin being the treatment of reference; CI, confidence interval; AIIFVL, all patients carrying the heterozygous factor V Leiden mutation; AIIFIIL, all patients carrying the heterozygous factor II G20210A mutation; AIIPS, all patients carrying a protein S deficiency. Front Cardiovasc Med. Effects of anticoagulant therapy on pregnancy outcomes in patients with thrombophilia and previous poor obstetric history. We do not capture any email address. It is fairly well known that the chemical changes caused by pregnancy create an increased risk for the development of dangerous blood clots. This can be a life-threatening situation. Disclaimer, National Library of Medicine I completely trust him. Luckily, I do not have it but I was shocked that the high risk doctor didnt even want to test me for it. I agree! wow! i have factor Is anyone else with Factor V only on baby aspirin? Others can be life-threatening. A family history of factor V Leiden increases your risk of inheriting the disorder. I am negative for Factor V but had a blood clot (hormones are my only risk factor). He isnt worried about the factor 5 being a concern. The Skyla IUD is a good choice for patients with inherited thrombophilias such as Factor V and MTFHR. Do those with experience have any advice for me? Careers. There are measurable increases in several clotting factors (I, II, VII, VIII, IX, and XII), decreases in protein S levels, and increased resistance to APC. Thrombophilia testing: A British Society for Haematology guideline. Having venous thrombosis in unusual or less common sites in the body. Anticoagulantsare indicated for such patients, not antiplatelet agents. We thus performed, in women with a single antecedent of unexplained fetal loss, a prospective trial comparing 2 antithrombotic therapies: low-molecular-weight heparin enoxaparin and low-dose aspirin. Abstract. I've had no prior blood clots, but my high risk ob is putting me on 40mg of lovenox a day starting tomorrow. Practice, DOI: https://doi.org/10.3122/jabfm.17.4.306. A Group Owner is a member that has initiated the creation of a group to connect with other members to share their journey through the same pregnancy & baby stages. Im afraid that I should be starting the Lovenox injections already? My GP and doctors at the Coombe who I've spoken to advise no treatment at all is needed, so no aspirin. 2023 MJH Life Sciences and Patient Care Online. Antiphospholipid/antiprotein antibodies, hemostasis-related autoantibodies, and plasma homocysteine as risk factors for a first early pregnancy loss: a matched case-control study. From the Hematology Laboratory, University Hospital, Nimes, France; the Department of Gynecology and Obstetrics, University Hospital, Nimes, France; the Hematology Laboratory, Montpellier 1 University, Montpellier; France; and the Equipe d'Accueil 2992, Montpellier 1 University, Montpellier; France. With my first pregnancy, my doctors pretty much laughed me off like I was being dramatic, despite all my symptoms. Can you use skyla if you have factor v leiden and mthfr heterozygote? These blood clots can be life-threatening. Group A (n = 61) was composed of patients with an oral dose of 100 mg aspirin daily, Group B (n = 59) consisted of patients using 40 mg enoxaparin and 100 mg orally aspirin daily, and Group C (n = 54) included patients using 40 mg enoxaparin daily during pregnancy.Results: Among the 174 patients who completed the study, the live birth and miscarriage rates were similar for the three groups (p = .843 and p = .694, respectively). 2016 Jan;293(1):81-86. doi: 10.1007/s00404-015-3782-2. Glad you tested negative though :). eCollection 2022. 2005-2023Everyday Health, Inc., a Ziff Davis company. This therapeutic trial took place in our Mediterranean Abnormal Pregnancy Study Program, which has led to the previously published Nimes Obstetricians and Haematologists (NOHA) studies on hemostasis-related risk factors for pregnancy losses.10-15 Patients were selected from those who had been referred to our laboratory by practitioners and obstetricians of the Southern French Region Languedoc-Roussillon because of at least one antecedent of pregnancy loss from the 10th week of amenorrhea. Found out well before I got pregnant, as I had a superficial blood clot in my leg, with no obvious cause/risk factors so they ran some tests. I have factor 5 Leiden as well and am only on baby aspirin. After 3 miscarriages, I put this post together for FAQs. Both of the patients aunts had developed VTE in their early 30s, without any known risk factors. I was told by my fertility dr & also my obstetrician to stay on aspirin til 36 weeks pregnant & clexane til delivery. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Neonates small for gestational age, defined as having a weight lower or equal to the 10th percentile corresponding to the gestational age at birth, were delivered by 7 of the 71 successful mothers treated with enoxaparin (10%) and in 7 of the 23 successful mothers treated by aspirin (30%; P = .04, Fisher exact test). The patient is healthy, has no chronic medical conditions,and takes no long-term medications. I went through 3 miscarriages. The rates of healthy live births were the same according to the type of the 3 principal thrombophilic disorders (P = .15). The study was approved by our local hospital ethics committee. Both are very common and this is probably a coincidence. High frequency of protein Z deficiency in patients with unexplained early fetal loss. There were no complications with the delivery. Accessed June 4, 2018. Sanson BJ, Friederich PW, Simioni P, et al. Or decide to take aspirin without a prescription for any reason? All rights reserved. Factor V Leiden (FAK-tur five LIDE-n) is a mutation of one of the clotting factors in the blood. A total of 160 patients with heterozygous factor V Leiden mutation, prothrombin G20210A mutation, or protein S deficiency were given 5 mg folic acid daily before conception, to be continued during pregnancy, and low-dose aspirin 100 mg daily or low-molecular-weight heparin enoxaparin 40 mg was taken from the 8th week. Inheriting one copy slightly increases your risk of developing blood clots. A single copy of these materials may be reprinted for noncommercial personal use only. Charity disappointed government are not prioritising fertility treatment, Tracy's Fertility Journey: 'They told me I had loads of timeI stupidly waited two years'. Use of a Feed-Forward Back Propagation Network for the Prediction of Small for Gestational Age Newborns in a Cohort of Pregnant Patients with Thrombophilia. Low-molecular-weight heparin in addition to low-dose aspirin for preventing preeclampsia and its complications: A systematic review and meta-analysis. I'm currently about 8 weeks pregnant, doctor told me to start baby aspirin till get test back that confirm hetero or homozygous. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Vicoveanu P, Vasilache IA, Scripcariu IS, Nemescu D, Carauleanu A, Vicoveanu D, Covali AR, Filip C, Socolov D. Diagnostics (Basel). Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Barker DJ. Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome. thank you for sharing! During my previous pregnancy I had my son at 32 weeks and he was also growth restricted my placenta began not working properly. WebFor people who have homozygous FVL (copies of the bad gene inherited from both parents) the risks of clotting are forty to 100 times the risk for someone with normal Factor V. Pregnancy is also associated with a 5- to 6-fold increase in the risk of VTE. 0 to post a comment! Between 3 and 8 percent of people with European ancestry carry one copy Make a donation. I was put on aspirin 75mgs & clexane injections. Mutations in factor V Leiden homozygous and heterozygous were determined. New York, N.Y.: McGraw-Hill Education; 2016. https://accessmedicine.mhmedical.com. My mom is Herero factor v and I told my high risk doc - she said since none of my immediate family members have had a clot, I shouldnt even be tested. Protein Z influences the prothrombotic phenotype in factor V Leiden patients. How severe is factor v leiden (homozygous)? Apologies in advance as this is long and detailedand thanks for reading! FOIA Doctors are certain that they won't prescribe clexane or aspirin and that's my GP plus two drs in the Coombe.I wonder does your friend have homozygous, which I know is more serious. This pathophysiologic perception has been reinforced by a demonstration, in the late 1990s, mainly by means of a series of case-control studies performed after the first one published by Sanson et al,2 that thrombophilic disorders in the mother are associated with an increased risk of fetal loss, before or after (stillbirths) 22 weeks of gestation. I forgot to mention I have had a previous normal pregnancy/ birth with almost 10 pound baby and had know idea about the factor v at that time. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Clinical characteristics of the patients included in the study. The patient was counseled about obtaining a maternal serum -fetoprotein test, which she agreed to have done. Frequency Factor V Leiden is the most common inherited form of thrombophilia. If your father is homozygous for the mutation, you are heterozygous for factor v leiden. For potential or actual medical emergencies, immediately call 911 or your local emergency service. WebFactor V Leiden and Pregnancy The increased risk for blood clots caused by pregnancy combined with the increased risk for blood clots caused by Factor V Leiden should be taken very seriously. Live birth rates were 116 (71.6%) of 162 in the LMWH group, and 112 (70.9%) of 158 in the standard surveillance group (no statistical difference). I cannot take baby aspirin because I have colitis so I really watch what I do. Factor V Leiden means an increased risk of deep vein thrombosis and medically important blood clots. Some studies have found that having the Factor V Leiden mutation means an increased risk of recurrent miscarriages, possibly because of tiny blood clots blocking the flow of nutrients to the placenta. Low molecular weight heparin for the prevention of obstetric complications in women with thrombophilia. She had not taken her heparin that morning. doi: 10.1002/14651858.CD004734.pub3. My hemotologist always said if I ever got pregnant I'd have to be on the injections but I haven't went back to him since getting pregnant so I don't know either I'm wondering the same thing as you. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Since factor V Leiden is a risk for developing blood clots in the leg or lungs, the first indication that you have the disorder may be the development of an abnormal blood clot. Prolonged surgery with general anesthesia. Nelen WL. I have the same, due to 4 consecutive miscarriages I was put on lovenox injections with my 5th pregnancy, my doctor told me to call and get blood test for HCG and I was put on it at 4 weeks 2 days pregnant. I would get a second opinion for sure and advocate for yourself. The question that remains is:what is the optimal prophylactic regimen?Aspirin (choice A) is not appropriate for a patientwho is heterozygous for factor V Leiden. I was diagnosed with the condition after I developed a massive deep vein thrombosis (DVT) in my left leg. Aspirin; factor V Leiden mutation; live birth; low molecular weight heparin; recurrent pregnancy loss. Anti-protein Z antibodies in women with pathologic pregnancies. On the intake interview, the patient denied any significant past medical history or family medical history, including thromboembolic disease. Both treatments were administered at 8:00 p.m. Because umbilicoplacental circulation increases from the eighth week,1 thromboprophylaxis systematically began at the beginning of the 8th week of amenorrhea after a positive pregnancy test. Kaandorp S, Di Nisio M, Goddijn M, Middeldorp S. Cochrane Database Syst Rev. https://www.uptodate.com/contents/search. Fetal programming of coronary heart disease. But I would want to be really sure if it is going to stress you out. Hi sorry for your losses & congrats on your BFP. 2021 May 24;18(6):1525-1534. doi: 10.5114/aoms/136518. The endpoints of the study were the following: live birth rates, pregnancy losses from the beginning of the eighth week, hemorrhagic complications in the mother and in the newborn, weight of the neonates, any complications during pregnancy, and any abnormal manifestation in the newborn. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. She was referred to a maternal-fetal medicine specialist (MFM) for genetics counseling and level II ultrasound. Its the most common blood clotting disorder thats Case-control study of the frequency of thrombophilic disorders in couples with late fetal loss and no thrombotic antecedent. Results of the level II ultrasound were negative for NTD. It was difficult to imagine that the 2 laboratories, the one producing aspirin and the other producing the LMWH, would accept to collaborate in the same trial, potentially leading to only one of them supporting the trial. Thanks for sharing! Gris JC, Amadio C, Mercier E, et al. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. Glad to hear your first pregnancy was uneventful, and I hope this pregnancy is as well! Is there a link between hemangiomas and factor v leiden mutations? Gris JC, Quere I, Sanmarco M, et al. The test revealed that the patient was heterozygous for FVL. WebFVL, factor V leiden hetergynous and pregnancy . Those who are heterozygotes their risk is 5-1 People homozygous for factor v leiden are about 50 times more at risk of developing blood clots in their veins and complications related to that. The study randomized 326 women to the two treatment arms; the most common thrombophilia types were factor V Leiden (56%), prothrombin gene mutation (25%), and protein S deficiency (14%). So, in absence of sufficient institutional funding, we chose not to perform a double-placebocontrolled trial, and we think that our results are likely to be independent from industrial influences. Could i fly with heterozygous factor v leiden and existing clot? For these, please consult a doctor (virtually or in person). The patient returned to the family practice clinic for continued prenatal care. Thanks for the reply and sorry to hear of your own losses too. People who have inherited factor V Leiden from only one parent have a 5 percent chance of developing an abnormal blood clot by age 65. https://www.uptodate.com/contents/search. The publication costs of this article were defrayed in part by page charge payment. A recent study showed that exposure to aspirin during pregnancy increases miscarriages.21 The risk was however limited to the prenatal use of aspirin and treatments. My haemotoligist explained that I was relatively low risk, as I had tested negative for other types of mutations that increase the risk of clots. Women who carry the factor V Leiden mutation may have an increased tendency to develop blood clots during pregnancy or when taking the hormone estrogen. In: Williams Hematology. This site complies with the HONcode standard for trustworthy health information: verify here. An Inside Blood analysis of this article appears in the front of this issue. Objective: The aim of this study was to compare the effects of low molecular weight heparin (LMWH), LMWH plus low dose aspirin, or low dose aspirin only on pregnancy outcomes in recurrent pregnancy loss (RPL) patients with factor V Leiden mutation (FVLM).Materials and methods: A total of 2764 RPL patients were evaluated in for the etiology of RPL. Our patients receiving low-dose aspirin had a good outcome in roughly one third of the cases. WebThe Leiden mutation has been significantly related to pregnancy complications associated with hypercoagulation, e.g. Hopefully my doctor there can give me more insight. Please enable it to take advantage of the complete set of features! The vast majority of those with factor v leiden mutation will never have a clot, but the risk is increase during pregnancy, bed rest etc. Orthopedic injury that results in splinting/casting andimmobility (as was the case with this patient's brother). No significant differences, in terms of age, number of pregnancies, moment of fetal loss, body mass index, or categories of these 4 clinical criteria (as defined in Table 1) could be evidenced. The patient presented to Labor & Delivery in spontaneous labor at 37 + 0 weeks. Pregnant by 3rd month trying, baby measure right size, heartbeat. Bookshelf I think it would be worthwhile getting a second opinion though, if possible from a haemotoligist. Most patients, because of moral suffering but also because of abundant data currently available, (ie, on the Web), concerning the use of LMWH during at-risk pregnancies, do not accept it. WebPrior studies were retrospective and highly subjective in nature and most caregivers are comfortable with the common baby aspirin per day regimen as a;cant hurt, might help option. My blood test said I had one copy of the factor V Leiden mutation, and the doctor said to take one low-dose aspirin a day. Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: a meta-analysis. WebFactor V Leiden (pronounced FAK-ter five LYE-den) is a blood clotting disorder that raises your risk of abnormal blood clots. 2022 Apr 16;12(4):1009. doi: 10.3390/diagnostics12041009. Red blood cell methylfolate and plasma homocysteine as risk factors for venous thromboembolism: a matched case-control study. I'd get a second opinion- maybe speak with someone who is familiar with that particular condition. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. During pregnancy, persons with FVL are at increased risk for VTE, IUFD, IUGR, placental abruption, and preeclampsia. This requires both its activation by the binding of the thrombin-thrombomodulin complex to endothelial cells and the presence of protein S and ionized calcium.1 Any disruption of this pathway will result in a predisposition to venous thrombus formation. Thank you I'd like to hear what they say bc I'm also concerned about that. No case was seen of digestive intolerance to low-dose aspirin either. With my daughter, I had chronic placental abruption which led to an infection of the placenta. So although most people will During her pregnancy and postpartum period, she had no evidence of a VTE. government site. 8600 Rockville Pike Glad to hear the Lovenox shots are doing their job for you!! I was diagnosed with factor five leidon after this, and also have elevated levels for another clotting disorder (do not know the name which is why I have to take 150 mg of asprin). 2009 Feb;36(2):279-87. doi: 10.3899/jrheum.080763). In patients taking aspirin, losses occurred between the 11th and the 18th week of amenorrhea (median, 15; lower and upper quartiles, 13 and 16). You may have been tested for the condition known as factor V Leiden (pronounced factor five lye /-den) because you or someone in your family has had a Antiphospholipid and antiprotein syndromes in non-thrombotic, non-autoimmune women with unexplained recurrent primary early fetal loss. And glad you dont have it! My doctor says 1-2 miscarriages is normal, 3+ is not and it is being caused by something. considering this is my so far 3rd healthy pregnancy (with lovenox) is day its doing its job! Effect of the two treatments on pregnancy outcome. Having a strong family history of venous thromboembolism. Group Leaders arent expected to spend any additional time in the community, and are not held to a set schedule. Financial Incentives Are Associated with Lower Likelihood of COVID-19 Vaccination in Northeast Ohio, The Prevalence of Low-Value Prostate Cancer Screening in Primary Care Clinics: A Study Using the National Ambulatory Medical Care Survey. Limitation: Venous thromboembolism was a secondary end point in the Women's Health Study. I have factor v leiden. Finally, the ultimate inclusion criteria were one single unexplained pregnancy loss from the 10th week of amenorrhea with no unexplained pregnancy losses before the beginning of the 10th week of amenorrhea and no explained pregnancy losses associated with a factor V Leiden mutation, a factor II G20210A mutation (all heterozygous), or a protein S deficiency (performed as previously described11; functional activity in a procoagulant assay and free protein S antigen all lower than 55% of normal values). Ying ZF, Huang ZF, Cui J, et al. The study is created by eHealthMe from 11 Aspirin i have factor v leiden. Most authorities recommend prophylactic anticoagulationfor the duration of the pregnancy and during thepuerperium, when the thromboembolic risk remains elevated.Others might confine treatment to the last trimesterand the puerperium, when the incidence of venous thromboembolismis highest. Pregnancy, which may increase an individual womans risk of VTE by 5- to 6-fold,2 represents such a condition. The neonate weight was higher in the 69 women successfully treated with enoxaparin (median, 3043 g; interquartile range, 373 g; range, 2310-3787 g) than in the 23 women treated with low-dose aspirin (median, 2742 g; interquartile range, 522 g; range 2010-3268 g) (P = .0005). thank you, Is the hcg diet safe with factor v leiden. Some clots do no damage and disappear on their own. The .gov means its official. Solve this simple math problem and enter the result. Middeldorp S. Antithrombotic prophylaxis for women with thrombophilia and pregnancy complicationsno. The patient had normal blood pressure, and normal fetal heart tones were auscultated with a transabdominal Doppler. Stratification of the included patients with one unexplained pregnancy loss from the 10th week of amenorrhea, according to the principal underlying thrombophilic disorders, and effect of the two treatments on the rate of live births. Mayo Clinic does not endorse companies or products. Twelve of them had an early pregnancy loss, before the eighth week and before the beginning of one of the treatments. Relative hazards associated with aspirin use in higher-risk subgroups were 0.83 (CI, 0.50 to 1.39) among women with either factor V Leiden or the prothrombin mutation and 1.36 (CI, 0.77 to 2.41) among those with a history of VTE. To learn more, please visit our, You can take all these if they have been recommended to you by your doctor. Symptoms of a blood clot depend on what part of your body is affected. Please select a reason for escalating this post to the WTE moderators: Connect with our community members by starting a discussion. Preventing adverse obstetric outcomes in women with genetic thrombophilia. So Ive noticed that a couple women on here have Factor V Leiden. WebFactor V caused recurrent miscarriage through an increased risk of blood clots at the tiny vessels feeding the pregnancy. The patient had felt fetal movements a few days before her office visit. The second one,9 because of the absence of controlled studies, does not support the use of LMWH. Hi all, I'm posting in case anyone here is in a similar boat or might have some advice. Create an account or log in to participate. WebObjective: The aim of this study was to compare the effects of low molecular weight heparin (LMWH), LMWH plus low dose aspirin, or low dose aspirin only on pregnancy outcomes in recurrent pregnancy loss (RPL) patients with factor V Leiden mutation I've been told to stop taking aspirin now but am reluctant to do so in case there is even a small risk of miscarriage due to the clotting issue. Initiate warfarin and titrate dosage to achieve an INR of 2 to 3; continuefor the full term of the pregnancy.C. First pregnancy factor v leiden and lovenox f freckled Jun 10, 2010 at 10:43 PM I'm fortunate to have been diagnosed with factor v before I got pregnant due to my mothers diagnosis. It was an extremely painful and somewhat traumatic pregnancy and Im terrified that the same thing will happen again. Patients on low-molecular-weight heparin should be changed to unfractionated heparin at 36 weeks to minimize the risk of epidural hematoma from regional anesthesia. I have seen the specialist 3 times, once for each baby and all three times they said lovenox is not something they would have put me on and I dont have to take it my doctor says since I have a clotting disorder she recommends me keep taking them, especially since I had 5 losses when I was taking no lovenox. Im 22, I had all 4 of my miscarriage at 20 Im completely healthy. Before getting the results I had already begun taking 75mg aspirin from the day of my bfp (not prescribed) in case I had a clotting disorder as I didn't want to risk anything going wrong while I wanted for results. That makes me feel a bit better. He explained that the risk was moderate in the early stages, and trends upwards as pregnancy progress (but still not particularly high given lack of other mutations). Its sad that many Obs (and doctors in general) dont err on the side of caution. Our patients had the 3 constitutional thrombophilic disorders that have been validated by the available meta-analysis of the published studies,3 and mainly the 2 that are the most frequently diagnosed, namely the factor V and factor II mutations. PMC Medical history with specific attention to obstetric history (pregnancies; childbirth; treatments; infectious disease during pregnancy, including HIV, erythroblastosis fetalis Rh-negative disease, immune thrombocytopenic purpura [ITP], and fetomaternal alloimmune thrombocytopenia [FAT]; gravidic hypertension and its complications; trauma; obstetric complications; diabetes mellitus; morphologic malformation in the dead fetus) was taken into consideration by investigators who were unaware of the laboratory results. The patient was encouraged to stop smoking, given miscarriage precautions, and told to return to the family practice clinic in 4 weeks. Accessed June 4, 2018. Some doctors put women on a low dose of aspirin, some do nothing and some prescribe clexane / heparin injections. Can i take advil if i have a heterozygote mutation of factor v leiden? Barbara Woodward Lips Patient Education Center. We looked for presumptive etiologic factors: hysterosalpingogram, karyotype in both parents, glucose tolerance test, toxoplasmosis serology, thyroid function, serum prolactin levels, normal luteal phase of at least 12 days and plasma progesterone above 25 ng/mL, absence of antinuclear factor, or antiphospholipid/antiprotein antibodies (lupus anticoagulant, anticardiolipin, anti2-glycoprotein I, antiannexin V, anti-phosphatidylethanolamine, immunoglobulin G [IgG], and IgM, by the methods previously described in our laboratory12,15), absence of antithrombin or protein C deficiency,11 fasting plasma total homocysteine lower than 15 M/L. I have heterogeneous factor 2 prothrombin thrombophilia. This pregnancy I am on baby asprin and 60mg of clexane. In any event, observation only(choice C) is insufficient. The warfarin is continued for 6 to 12 weeks postpartum. Nonsevere preeclampsia developed in 7 cases, 4 women treated by enoxaparin and 3 with low-dose aspirin, with no pejorative secondary consequence for the women or their neonate. The injections aren't pleasant (but you get used to it) but given the option I'd err on the side of caution.
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