Expert: Dr Ian Jackson - please note UK based - 11/12/2007

Question
Hello,
I am so happy to find this service and wondering if you can help. I am 38 weeks pregnant. I have thrombophilia and have taken Lovenox (30mg injection a day) and baby aspirin (1 per day) my entire pregnancy. I am also on Procardia for preterm labor. If I go off of the Procardia and go into labor without coming off the baby aspirin and Lovenox, can I still have an epidural?  When should I stop the lovenox/baby aspirin? Each dr tells me something different and I am still so unsure.
Thanks in advance from a concerned patient -Colleen

Answer
Colleen
As you are on both heparin and aspirin it sounds like you may have antiphospholipid syndrome (one of the many thrombophilias).
It is a difficult call as to the right time to stop. I assume you are on a once daily dosing of the Lovenox - if you are on a lowish dose then an epidural could be sited after 10-12 hours from your last dose. If you are on a higher dose then the anaesthetist would want to leave it longer and probably do a clotting check to ensure all is OK.
The aspirin is more difficult - this stops your platelets sticking together and so can make bleeding from any injury last longer. It would need to be stopped some 10 days before delivery to allow new platelets that have not been affected by the aspirin to be produced.
This then all has to be linked to the risks of a DVT if you stop these drugs.
It is important to remember that there are alternatives to epidurals and you may not need one. When faced with similar problems we chat through the issues with the patient and then agree a suitable way forward with them, this can include an epidural but often we use a Patient Controlled Analgesia system that gives short acting pain killers into a vein. This discussion needs to be done before you go into labour so you can think it all through _ without the pain of contractions!
So I suggest you need to meet the anaesthetic team to discuss what will happen.
I wish you all the best
Kind regards
Dr Ian Jackson