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Old 11-27-2012, 11:31 AM   #1
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coumadin, heprin, lovenox

My friend had a baby 2 weeks ago and was admitted to the hospital yesterday with a bloodclot in her groin.

The drs want to put her on coumadin, lovenox, and/or heprin. She was ebf the baby and is now worried. I Googled and saw that lovenox and heprin are safe for baby but that coumadin is controversial.

Anyone here use these In any combination? I want to give her info so she can make a decision because she is leaning towards stopping bf. She right now is pumping and dumping.

Any input, advice, or btdt is appreciated.
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Old 11-27-2012, 03:49 PM   #2
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Re: coumadin, heprin, lovenox

I took heparin for 6 wks pp with DS....and I'll probably be on something (heparin or low molecular weight heparin (lovenox)) after our next baby, too. My vote is to take whatever has the least required doses per day (heparin was 2x/day for me--I think Lovenox will be 1x/day)...just to reduce the hassle factor. Nursing a new baby is stressful enough without having to worry about multiple daily injections. Of course, cost may also be a factor (lovenox is much more spendy than heparin). Tell her not to stop BFing over this! The clot will be resolved soon...much harder to deal with formula for the next year plus.

ETA: Just found this, too. http://www.drugs.com/breastfeeding/heparin.html
And this http://www.drugs.com/breastfeeding/enoxaparin.html
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Old 11-27-2012, 08:35 PM   #3
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Originally Posted by aaiya
I took heparin for 6 wks pp with DS....and I'll probably be on something (heparin or low molecular weight heparin (lovenox)) after our next baby, too. My vote is to take whatever has the least required doses per day (heparin was 2x/day for me--I think Lovenox will be 1x/day)...just to reduce the hassle factor. Nursing a new baby is stressful enough without having to worry about multiple daily injections. Of course, cost may also be a factor (lovenox is much more spendy than heparin). Tell her not to stop BFing over this! The clot will be resolved soon...much harder to deal with formula for the next year plus.

ETA: Just found this, too. http://www.drugs.com/breastfeeding/heparin.html
And this http://www.drugs.com/breastfeeding/enoxaparin.html
I think this is protocol/practice for at risk mamas without a current clot. Like APS mamas, no clot, through postpartum.

Those w APS or other clotting issues and a clot are on Coumadin (or equivalent) for the duration... Like indef.

Those w a clot w no known risk (except causation ie pregnant/post partum, surgery, birth control etc) are on Coumadin or other prophylaxis for a standard 6 months.

Now it's been a while since I've immersed myself in all the literature, but I think that's how it went.

I was toss up bc I had transient elevations for APS, w recurrent mc, w no clotting.


Hughes syndrome is the name for antiphospholipid syndrome in the UK. They have a great forum for mothers with APS, and if anyone has experience in this area I think it would be them. They are a great group of women.
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Old 11-27-2012, 06:35 PM   #4
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Re: coumadin, heprin, lovenox

No way would I BF with coumadin. My grandma is on it for blood clots. It isn't worth the risk, IMO. I would pump and dump.
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Old 11-27-2012, 07:46 PM   #5
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Re: coumadin, heprin, lovenox

She needs to discuss this with her doctors and they can tell her all the risks associated with breastfeeding on certain drugs and their side effects. They can also discuss choices to put her on medications that have less breastfeeding side effects but still keep her healthy. It may depend on what her insurance will pay for and also what is best for her health. Normally, I believe they keep you on an anticoagulant (such as coumadin) for 6 months following a clot. (Unless you have a medical reason to stay on them longer such as Antiphospholipid protein disorder.) Although I think researching this for your friend is very nice ... I think the best answers for what to do long term are going to be based on what course of treatment the doctors decide for the next 6 months. I'm pro-breastfeeding. But I'd never expect a person to pump and dump for 6 months just so they could try to breastfeed later. (After a baby is bottle fed for 6 months...it might be hard to go back to the breast. And 6 months of pumping and dumping is a lot of time wasted that could be spent enjoying her baby.) The heath of your friend will have to be the most important thing. While breastfeeding is a wonderful thing, many moms are not able to because of many reasons includin presicription medication. I hope you will be extra supportive if she is unable to continue because I'm sure it will be a disappointment to her.

PS. Your friend is very lucky they caught the clot and I hope that she is doing well and has a speedy recovery.
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Old 11-27-2012, 08:10 PM   #6
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I would pull the reports from Dr Hale. I would consider the heparin only as it is short acting and can be removed by another medication quicker than lovenox (protamine sulfate) in the event it must be.

Last I read it was 60% lovenox removal:[to]"neutralization" (heparin). I understood it to be .60 lovenox removal : 1 heparin removal.

No way in he!! I would nurse w Coumadin. It is Cat X.
I, too, would consider weaning unless there was documented blood plasma levels drawn from babies nursed by mothers on heparin. Even then... it would have to be iron clad evidence and babys pediatrician would need to check his bleed times for me to sleep.

I had elevated clotting factors during pregnancy wo a clot. Lovenox was given briefly and I stayed on ASA the duration w 1. The beginning w the second child.

Lots of talking w doctors on her part. Lots.

Last edited by Numommy; 11-27-2012 at 08:17 PM.
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Old 11-28-2012, 08:03 AM   #7
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Re: coumadin, heprin, lovenox

She needs to contact Dr. Hale directly (infantrisk.com). They can guide her to the best choices and whether there are alternatives that may allow her to continue breastfeeding.
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Old 11-28-2012, 05:32 PM   #8
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Thanks everyone.... She is researching also, and is consulting with her doctors.... I value the opinions of (most) of the people on ds... So I wanted to see what you had to say...

Thanks again!
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Old 11-28-2012, 09:04 PM   #9
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Re: coumadin, heprin, lovenox

i had surgery on the 12th had heprin in the hospital and was on lovenox for 7 days after.
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