Heparin has an average half-life of 60-90 minutes but is longer at higher doses. Although, the low molecular weight heparin is considered safe to use with regards to pregnancy, the Unfractionated Heparin version used before had several health risks associated with it. What Is Heparin and Why Is It Recommended During Pregnancy? Since LMWH does not cross the placenta, experts recommend it as it causes no side effects to the foetus. A DVT can limit blood flow through the vein, causing swelling and pain, but there is a risk that it can break off and travel through the blood stream. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Other advantages are decreasing thrombophilic risk in COH ( controlled ovarian . Studies reported only as abstracts were eligible for inclusion and would have been placed in studies awaiting assessment, pending the full publication of their results. Hold the syringe in a dart fashion and insert the needle directly into the skin at a 45-90 degree angle just into the . Heparin has no known metabolites when broken down by the body. Experts have theorized that heparin may prevent recurrent miscarriages even in patients who test negative for antiphospholipid antibodies. PE occurs more commonly during the postpartum period than during pregnancy (relative risk = 15.0; 95% CI, 5.1 to 43.9),4 and 64 percent of postpartum VTEs occur after cesarean delivery. However, they are harmful because they are associated with an increased risk of thromboembolic, hemorrhagic, or microcirculatory disturbances or placental dysfunction leading to fetal growth restriction or loss. See references Heparin flush Breastfeeding Warnings LMWH (Low Molecular Weight Heparin) is mostly recommended because it never crosses the placenta, and therefore no side effects are caused to the child. Although receiving subcutaneous heparin (either unfractionated heparin (UFH) or low molecular weight heparin (LMWH)) is the main option in the prevention of VTE during pregnancy, the management of thromboprophylaxis in pregnant women has mostly relied on the evidence from non-pregnant participants. I tend to insert the needle and inject the heparin slow too. Your risk of developing a thrombosis will be assessed in pregnancy and after the birth of your baby. Take Steps to Protect Yourself and Your Baby from Blood Clots During Pregnancy and After Delivery Know the signs and symptoms of blood clots A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). Before you handle the syringe or vial of heparin, you should wash your hands thoroughly. This medication is a commonly used anticoagulant in modern times. Warfarin, another anticoagulant taken in tablet form, does cross the placenta and may harm the unborn child (tetrogenic). Heparin is a form of anticoagulant used to prevent blood from clotting. interactive elements on the site, any assistance, or response you receive is provided by the author If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Opioid use during pregnancy can affect women and their babies. CDC twenty four seven. 4 0 obj However, this review found no randomised controlled trials to show which methods of receiving subcutaneous heparin are effective and safe for pregnant women. collection of VTE educational resources published by The Joint Commission. 2013;2013:1-9. doi:10.1155/2013/516420, Kaandorp SP, Goddijn M, Van der post JA, et al. While working as an intern for an English daily, she realised that she likes writing above anything else. Study with Quizlet and memorize flashcards containing terms like While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. i hope that this hasbeen some help. For individuals with antiphospholipid syndrome, the benefits of heparin usually outweigh the risks. Your doctor can discuss the costs and benefits of taking heparin to help you understand what side effects to look out for and decide whether it's right for you. Choose a site on the right or left side of your belly, at least 5 centimetres (2 inches) from your belly button. Learn about Blood Clots. This content is owned by the AAFP. The best places for you to inject into are: The U-shape area around your belly button. . Pregnant women have an increased risk of venous thromboembolism (VTE) when compared with non-pregnant women because of changes in blood clotting. Your tummy is usually best as the injection site. Therefore it is considered that heparin is safe for you to have whilst you are breastfeeding. <> Thromboprophylaxis during pregnancy By subcutaneous injection Adult 5000-10 000 units every 12 hours, to be administered with monitoring, Important: prevention of prosthetic heart-valve thrombosis in pregnancy calls for specialist management. It is not known whether heparin is excreted into breast milk. 2.1 Preparation for Administration. zo90q |%()J 69#YVWpC(H#Vg g Art. While multiple contributing factors may be involved, sadly about 50% to 75% of the time, there is no known cause for recurrent miscarriages. Right now I have a HUGE cruise on my right side because I scratched my tummy on a chair so I've been injecting just on the left side for about 2 weeks and I've been fine. Side effects of heparin treatment may include bleeding and decreased bone density. Centers for Disease Control and Prevention. It is often used prior to surgery to prevent blood clotting. Methods of receiving heparin subcutaneously include giving an injection at regular intervals, or using an indwelling catheter and an infusion pump. Already on long-term anticoagulation, e.g. :) I do heparin twice a day, on my morning injection I do the left side and in the evening I do the right side. Againsure wish I had gotten some guidance from my dr. And, I thank you in advance for any guidance you ladies can give me! Thank you for any advice;-(. Warfarin is NOT to be taken when pregnant because it will effect the baby so Lovenox / heparin shots are often prescribed seeing as it is faster acting . Side effects of heparin treatment may include bleeding and decreased bone density. In rare conditions, the mother might also suffer from alopecia and osteoporosis. And then administer the injection ask your Dr he could prescribe it. Pregnancy Complications Caused by Heparin. Sit in a comfortable position so that you are relaxed. All rights reserved. Monitoring for these is part of your clinic visit, but the more serious side effects are almost never seen with LMWH use in pregnancy. I took heparin during my pregnancies (after having a DVT). Therefore, precaution should be taken before using any blood thinners, especially if you are pregnant. Symptoms of dyspnea are nonspecific in pregnancy. Heparin. she suggested that I give my shots directly instead of at an angle which has really made a difference. I haven't done anything differently that I'm aware of. Also, heparin is usually administered around the abdomen area where the fatty layers of the stomach do not permit the needle to get close to the foetus and harm it. If available, preservative-free heparin sodium injection is recommended when heparin therapy is needed during pregnancy. Should I have it checked? We use cookies to improve your experience on our site. Simcox L, Ormesher L, Tower C, Greer I. Thrombophilia and pregnancy complications. In addition to the treatments described, calcium and vitamin D supplements can be prescribed to reduce the risk of heparin-induced osteoporosis (reduced bone strength). UFH is considered an acceptable alternative.32 Table 1 recommends dosages and monitoring.10,12,32,41 For postpartum DVT or PE, warfarin may be started concomitantly with heparin.42 LMWH or UFH should be continued until an international normalized ratio of 2.0 to 3.0 is achieved for two consecutive days.42 Post-thrombotic syndrome can be prevented if compression stockings are worn for at least one year starting in the first month after a DVT.1, Intrapartum management may vary depending on the indication for anticoagulation and whether therapeutic or prophylactic doses have been used.10 Expert guidelines suggest that women receiving adjusted-dose LMWH or UFH be instructed to discontinue heparin injections at the onset of labor to prevent anticoagulant complications during delivery.12,32 When delivery is predictable, as for elective induction or planned cesarean birth, LMWH or UFH should be discontinued 24 hours before delivery.12,32 For high-risk patients, such as those with mechanical heart valves or recent VTE, the American College of Obstetricians and Gynecologists (ACOG) recommends switching to intravenous heparin at the onset of labor.10 The short half-life of intravenous UFH allows discontinuation four to six hours before the anticipated time of delivery.10,32 To minimize spinal and epidural hematoma risk, the ACOG and the American Society of Regional Anesthesia advise avoiding regional anesthesia for 24 hours after the last LMWH dose for women on twice daily therapeutic doses of enoxaparin (Lovenox), and for 12 hours after the last dose of LMWH for women receiving daily prophylactic dosing.10, Evidence is insufficient to recommend for or against an inferior vena cava filter if anticoagulation is contraindicated or repeat PE occurs despite adequate anticoagulation.1, Systematic reviews of observational studies have found VTE prophylaxis with LMWH to be safe and effective in pregnancy, but there are no randomized controlled trials confirming this.35,42 Table 2 lists representative prophylactic doses of LMWH and subcutaneous UFH.6,43 Table 3 summarizes recommendations for the type and duration of prophylaxis based on specific clinical risk factors.5,10,15,32,39,40 Consultation should be considered for high-risk thrombophilias such as antithrombin deficiency.6, Low-dose aspirin (75 to 81 mg) is sometimes used for women with an increased risk of thrombosis that does not meet the threshold for prophylactic heparin (e.g., a woman with a mild thrombophilia and no history of VTE).6 Due to the lack of studies of aspirin for this indication, such treatment is of unknown benefit; however, low-dose aspirin is safe to use during pregnancy.32, Postpartum thromboprophylaxis is not routinely indicated following vaginal delivery,42 but may become necessary because of labor-related risk factors, such as prolonged labor, mid-forceps delivery, and immobility after delivery.6, Unless other VTE risk factors are also present, women who undergo a scheduled cesarean delivery are not routinely placed on pharmacologic VTE prophylaxis.44 However, mechanical prophylaxis with pneumatic compression stockings has been shown to provide effective post-cesarean thromboprophylaxis.45 Graduated compression stockings provide effective prophylaxis in nonpregnant postoperative patients.46 A decision analysis comparing pneumatic compression stockings with no intervention for post-cesarean VTE prophylaxis found the former to be cost-effective.47. the most helpful and trustworthy pregnancy and parenting information. To comment on this thread you need to create a Mumsnet account. Consider the benefits and risks of heparin sodium for the mother and possible risks to the fetus when prescribing heparin sodium injection to a pregnant woman. A couple minor inconveniences to your day! Could be that I am a bigger girl but I have found that the heparin shots are much easier than the lovenox shots. Pregnant women may also experience less blood flow to the legs later in pregnancy because the blood vessels around the pelvis are pressed upon by the growing baby. Confirm the selection of the correct formulation and strength prior to administration of the drug. Another possible cause of recurrent miscarriage is a group of medical conditions that increase blood clotting, called thrombophilia disorders. It crosses the placenta and increases the risk of miscarriage, stillbirth, embryopathy (nasal hypoplasia or stippled epiphyses), central nervous system abnormalities, and maternal and fetal hemorrhage.32 Warfarin is compatible with breastfeeding.32, Data derived from nonpregnant populations suggest that therapeutic anticoagulation following a first episode of VTE should continue for at least six months from diagnosis.38 Current recommendations for the duration of treatment in pregnancy range from three to six months, including six weeks postpartum.10,12,32 Long-term (i.e., longer than 12 months) anticoagulation is indicated for women with VTE and antiphospholipid antibody syndrome, or two or more thrombophilias,39 and for women with any thrombophilia and recurrent thrombotic events.40. This means that is slows down blood clotting or thins the blood. It's purple, yellow, blue, and hard. DVT is potentially, and PE is definitely, life-threatening for both mother and baby. Myeloproliferative neoplasms (MPN) such as essential thrombocythemia (ET) and polycythemia vera (PV) are rare during pregnancy. If a very small amount passed into breast milk it is broken down by stomach acids therefore any absorption by a breast fed baby is negligible. I have to do enoxaparin injections once a day and started at 8 weeks (30 weeks now). The idea of being heard without having to speak appeals to her. % These injections are often provided alongside a low dose of "baby" aspirin. there are no side effects except maybe I bruised slightly easier. It is also deemed safe for women to breastfeed when theyre on LMWH injections. There is no evidence from randomised controlled trials to evaluate the best method of administering subcutaneous heparin to pregnant women. While everyone is at risk for developing a blood clot (also called venous thromboembolism or VTE), pregnancy increases that risk fivefold. Thank you for taking the time to confirm your preferences. Anticoagulant therapy during pregnancy is indicated for the treatment and prophylaxis of venous thromboembolic disease and for the prevention and treatment of systemic embolism associated with valvular heart disease and/or . Heparin is most often prescribed to prevent blood clots or miscarriages, and is usually given as a subcutaneous injection. Using epoetin alfa injection products increases the risk that blood clots will form in or move to the legs, lungs, or brain. As of 2020, the campaign has realized more than 300 million media impressions. Cochrane Database of Systematic Reviews 2013, Issue 3. Suitable injection sites include the sides of your tummy (avoiding the area near When all the heparin has been injected, slowly withdraw the needle at the same angle at which it entered, releasing the skin roll as you withdraw. I'm a fan of medical intervention of necessary but I am really worried about getting pushed about and rushed. Arterial blood gas monitoring (with the patient sitting upright for greatest accuracy), chest radiography, and electrocardiography (looking for right ventricular hypertrophy) can be done in unstable and immobile patients and may help diagnose PE or suggest other conditions. Approximately 1% of women experience recurrent miscarriages, according to the American College of Obstetricians and Gynecologists. Administer Heparin Sodium Injection by intermittent intravenous injection, intravenous infusion, or deep subcutaneous (intrafat, i.e., above the iliac crest or abdominal fat layer) injection. Slightly increased risk of a bruising (wound haematoma) if having a caesarean birth. When I first started it I would get really hard bumps and I bruised really bad. Women are also advised to take LMWH after the babys birth as the risk of blood clots are high during the first six weeks post-birth. Now that my belly is a lot bigger, I inject into my love handles or side of upper thigh (do that while sitting). : CD009136. The use of heparin and oral anticoagulants during pregnancy is problematic because these drugs have the potential to produce adverse effects in the mother and fetus. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Heparin, sometimes called "standard heparin," is available as a liquid solution injected directly into the blood (intravenous or "IV") and only given to hospitalized patients, for instance . You can access these resources either from the campaign web portal or directly through the links provided below: This video shares important information about blood clot signs and symptoms, and risks for blood clots in women who are pregnant or have recently delivered a baby. Insufficient safety data during pregnancy and lactation; To provide neuraxial anesthesia (e.g., epidural) option prior to induction of labor . Heparin, medically known as Unfractionated Heparin (UFH), is an anticoagulant which is used to stop blood clotting. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Some women might already be taking the injections, and some might begin during their term of pregnancy. Heparin this will be prescribed from the clinic but further prescriptions may be provided by your GP. Very rarely there may be allergic type reactions at the injection site or in the body generally, increased blood potassium level, an immune reaction called HIT (heparin induced thrombocytopenia) or possibly bone thinning. It is important that you change the site each time. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. With life-threatening PE, thrombolytic therapy, percutaneous catheter thrombus fragmentation, or surgical embolectomy may be used, depending on local resources.33 Good evidence about the effectiveness and safety of thrombolytic therapy is lacking.34 Empiric anticoagulation may be started if clinical suspicion is high, then discontinued if VTE is excluded.12. endobj Apply light pressure to the area with a cotton ball for a few minutes. Low-dose aspirin and low-molecular-weight heparin (LMWH . Haemodialysis Initially by intravenous injection Adult Using heparin during pregnancy is not without risk. Which Pregnant Women Benefit Most From Heparin During Pregnancy? 1997-2023 BabyCenter, LLC, a Ziff Davis company. Good luck. These should be stored out of direct sunlight but do not need to be refrigerated. So today I noticed that I have a HUGE bruise to the left of my belly button. Parenting.Firstcry.com accepts no liability for any errors, omissions or misrepresentations. Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. As far as the bruise/swelling, it probably won't be your last one, but hopefully it will get better! I have been on heparin shots for a bit now. 2.2 If you could give me some advice/tips, I would REALLY appreciate it!! A family or personal history of blood clots or a blood clotting disorder, Prolonged immobility (not moving a lot), such as during bed rest or recovery after delivery, Complications of pregnancy and childbirth, Certain long-term medical conditions, such as heart or lung conditions, or diabetes, Know the signs and symptoms of blood clots, A blood clot occurring in the legs or arms is called deep vein thrombosis (DVT). Heparin Sodium Market - Covid-19 Impact and Recovery Analysis: We have been tracking the direct impact of COVID-19 on this market, as well as the indirect impact from other industries. Warfarin (Coumadin) is not safe during pregnancy. Thrombophilia disorders are also thought to cause other issues with the placenta., Bloodwork helps identify certain markers to diagnose antiphospholipid syndrome. Some women may not self-administer heparin and must rely on others to give them their injections otherwise they stop using the heparin, thus exposing themselves to an increased risk of VTE. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids as part of medication-assisted treatment for opioid use disorder. The LMWH comes in preloaded syringes. We take your privacy seriously. Compared to other variants, LMWH is better absorbed, lasts longer, and isn't associated with as much bone loss., Studies on heparin for patients with known antiphospholipid syndrome are encouraging. She was on Lovenox for all three of her pregnancies. <>/XObject<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. There have been studies which conclude that usage of heparin, in general, is harmful to both the child and the mother. Heparin is broken down by stomach acids and so cannot be taken by mouth. V/Q scanning may be used if spiral computed tomography is unavailable. A PE may cause breathing problems, chest pain and coughing up blood but a large PE can cause collapse and may be life threatening. Therefore, we performed a literature review of fetal/infant outcomes following anticoagulant therapy during pregnancy. Heparin Injection can be injected under the skin or into a vein. Although its effect is not restricted to anticoagulation and also can modulate apposition , adhesion , and penetration of embryo . All Rights Reserved. There may be an increased tendency to bleeding. If eligible trials had been identified, trial quality would have been assessed and data extracted, unblinded by review authors independently. Breech baby at the end of Pregnancy and ECV, Pregnancy Related Pelvic Girdle Pain (PGP), Mendip Birth Centre - Southmead Hospital Bristol, Central Delivery Suite - Southmead Hospital Bristol, Spontaneous Rupture of the Membranes (SRM), Discharge Advice After an Epidural or Spinal Anaesthetic, Getting Breastfeeding off to a Good Start. Other diagnostic criteria for the syndrome include:. The only slight difficulty was that you can't have an epidural within 24 hours of your last heparin injection. The form of heparin that's preferred during pregnancy is called low molecular weight heparin (LMWH). Some people also swear by icing the area before they inject. It was commented on recently (last week) so it should not be too far back. DOI: 10.1002/14651858.CD009136.pub2, Copyright 2023 The Cochrane Collaboration. You can review and change the way we collect information below. How Heparin Helps Prevent Recurrent Miscarriages. According to this study: In women who have a history of venous thromboembolism, weight-adjusted intermediate-dose low-molecular-weight heparin during the combined antepartum and postpartum periods didn't reduce the risk of recurrence compared with fixed low-dose low-molecular-weight heparin.Further study is needed to determine whether intermediate-dose low-molecular-weight heparin may be more . The optimal treatment of VTE during pregnancy has not been studied via randomized controlled trials, and clinical recommendations are based on expert opinion.10,12,24,32, Stabilization is the first priority. Do not pre-press on the piston protrusion to remove air bubbles, as this may disturb the dosage of the drug. A clot arising during this or a previous pregnancy. After deep subcutaneous (intrafat) injections, tests for adequacy of dosage are best performed on samples drawn 4 to 6 hours after the injection. When I first started the Heparin they just told me not to put it in the exact same spot but they never said I couldn't do it on one side. The drug can be used prevent blood clots in lungs, veins, and arteries. Low-molecular-weight heparin has largely replaced unfractionated heparin for prophylaxis and treatment in pregnancy. Now that is the way we do all of them! (I was diagnosed with a Sub-clavian Vein thrombosis 2008, Thrombophillya test boarder line) I was not told then that it would affect any future pregnancies so this . Dont let a blood clot spoil your joy. Carefully remove the cap from the needle connected to the syringe filled with the drug Clexane. Begin unfractionated heparin at 333 u/kg subcutaneous and then 250 u/kg subcutaneous q 12 hours. How should this medicine be used? Shelly- instead of emla or ametop which both take 45mins to an hour to work, you could use xzylocane Coldspray, which works instantly you just spray it on but its cold!!!! Heparin is an anticoagulant, which prevents blood clotting. It is partially broken down and metabolized both by the liver and the reticuloendothelial system. Heparin is extensively a protein-bound medication. Select the site for the injection. It is to be administered by intravenous or deep subcutaneous routes. Treatment is usually started when the pregnancy is confirmed. In addition, Stop the Clot, Spread the Word was one of many CDC resources recognized in 2017 as an important asset in a collection of VTE educational resources published by The Joint Commission. Most commonly, venous thrombosis occurs in the deep veins in the legs, thighs or pelvis and this is called a deep vein thrombosis or a DVT. Good luck! The most commonly used in pregnancy is 'low-molecular-weight heparin' (LMWH). Warfarin is contraindicated during pregnancy, but is safe to use postpartum and is compatible with breastfeeding. LMWH is given as an injection. (I'm not sure if you are supposed to do so, but it seems to help me sometimes). Good luck and congrats!!!! Heparin should not be injected into a muscle. Doctors administer Heparin injections before . Of clinically suspected PE, only 4 percent are confirmed in pregnant patients, versus 30 percent in nonpregnant patients.17, Figure 1 presents an approach to the diagnosis and treatment of DVT in pregnancy derived from studies of non-pregnant patients.19,20 In nonpregnant women, a negative (low) d-dimer test combined with a low clinical probability score has a negative predictive value higher than 99.5 percent when a highly sensitive assay (e.g., enzyme-linked immunosorbent assay, latex turbidimetric assay) is used.19,20 However, d-dimer values increase progressively throughout pregnancy, and the ranges for normal values by gestational week are not yet universally established.21,22 Although a low d-dimer may be helpful in ruling out DVT, a positive (high) d-dimer result will be common during pregnancy and always requires confirmatory testing.12,20. stream ,VxB7fbFv`y`/_ Treat the intended injection with a cotton pad moistened with alcohol. Let your provider know if you or anyone else in your family has ever had a blood clot. There is no evidence from randomised controlled trials to evaluate the effectiveness and safety of different methods of administering subcutaneous heparin (UFH or LMWH) to pregnant women. Just curious as I am concerned I will develop more hard lumps. Expecting or Recently had a Baby? It is known as Low Molecular Weight Heparin (LMWH). It is used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) including during pregnancy and following certain types of surgery. It will depend on why you are receiving heparin as to when your injections will start. I have had to inject blood thinners several times, over the years. In extreme conditions, death has also been recorded. LMWHs are recommended for the treatment of acute DVT and PE in pregnancy because of equivalent or superior effectiveness and safety compared with unfractionated heparin. Multidetector-row (spiral) CT is the imaging modality of choice to evaluate for PE in pregnancy because, in nonpregnant patients, the diagnostic accuracy is equivalent to pulmonary angiography, and radiation exposure to the fetus is less than with a V/Q scan. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as her . I inject on both sides. (AND I had some NASTY ones during that time--unfortunately, it is very normal)!! 4. The three most common reasons for women starting heparin during pregnancy or after the birth are: For pregnant women and women who have given birth, heparin is the anticoagulant of choice and is recommended by the Royal College of Obstetricians and Gynaecologists. The Centers for Disease Control and Prevention (CDC) recommends a flu shot for all women who will be pregnant during the flu season, which is November through March. Brian Levine, MD, MS, FACOG, is board-certified in obstetrics-gynecology, as well as reproductive endocrinology and infertility (REI). x\_s=x8iu'I}pRN&_ v7/yY4g/d#e+Ll'o3[e]L4{)W>FhK?_.v3[IOg.tc:9L} Zp#%E^^GvMrTlf3y>>6qaf8t|E6J Campaign digital content is provided in ways that make it easy for you to share with friends and family and across your social media networks. Adjusted-dose low-molecular-weight heparin: Hold for 24 hours prior to induction ; Prophylactic LMWH: Hold for 12 hours prior to induction ; Alternative option: Substitute unfractionated heparin close to . He is the director and founding partner of CCRM New York and was named a rising star by Super Doctors from 2017 to 2019. You really want to make sure you aren't injecting in the same area. CDC and NBCA have launched new content for their digital public health education campaign called Stop the Clot, Spread the Word. These cookies may also be used for advertising purposes by these third parties. 'sAc6 fm/1Gdyzc%ott Make sure you're rotating spots so to not make one area more sore than other spots. The dose and length of. Women who take warfarin must switch to heparin or low molecular weight heparin before they become pregnant, since heparin or low molecular weight heparin (Lovenox, Fragmin) do not cross the placenta into the fetus. Venous thromboembolism is the leading cause of maternal death in the United States.
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