All,
I have a project I am working on this semester(my last before rotations) and I have hit the proverbial brick wall with finding information.
The project deals with women who are on Warfarin before becoming pregnant (say 5mg daily every day). Once the patient finds out they are pregnant, they are switched over to lovenox (enoxaparin). Post pregnancy they are switched back to Warfarin. What I have noticed in a few isolated cases is when these women are placed back on Warfarin post pregnancy they are typically on a larger dose(say 8mg four days per week and 6mg the other three). From the two cases that I have access to, the post pregnancy Warfarin dose is from 15% to 66% higher. The dose stays elevated from 6 months to a year and a half and then the patient returns to a pre-pregnancy dose. These women are typically on the Warfarin pre-pregnancy because of a pre-existing condition of a factor 2 or v mutation. One of my cases is a factor two mutation the other is a factor v mutation with a protein c mutation as well.
I know there are a variety of things that could be causing the increase in dose. Some of these could include breast feeding, increased vitamin use with vitamin k present in the vitamin and a myriad of other thing. My question is have you noticed this in your practices? If you have noticed this do you have any suggestions as to why the patients need more Warfarin post pregnancy? My last question is could the hypercoagulable state of pregnancy be lasting into the post pregnancy period? My purpose in this project is to decide if we possibly need to increase our monitoring post pregnancy. A second purpose is to find out if there is a need for continuing lovenox for a longer period post pregnancy.
I have done an extensive pubmed search for research that addresses my research issue. I have found none. I hope you can help.
DR
I have a project I am working on this semester(my last before rotations) and I have hit the proverbial brick wall with finding information.
The project deals with women who are on Warfarin before becoming pregnant (say 5mg daily every day). Once the patient finds out they are pregnant, they are switched over to lovenox (enoxaparin). Post pregnancy they are switched back to Warfarin. What I have noticed in a few isolated cases is when these women are placed back on Warfarin post pregnancy they are typically on a larger dose(say 8mg four days per week and 6mg the other three). From the two cases that I have access to, the post pregnancy Warfarin dose is from 15% to 66% higher. The dose stays elevated from 6 months to a year and a half and then the patient returns to a pre-pregnancy dose. These women are typically on the Warfarin pre-pregnancy because of a pre-existing condition of a factor 2 or v mutation. One of my cases is a factor two mutation the other is a factor v mutation with a protein c mutation as well.
I know there are a variety of things that could be causing the increase in dose. Some of these could include breast feeding, increased vitamin use with vitamin k present in the vitamin and a myriad of other thing. My question is have you noticed this in your practices? If you have noticed this do you have any suggestions as to why the patients need more Warfarin post pregnancy? My last question is could the hypercoagulable state of pregnancy be lasting into the post pregnancy period? My purpose in this project is to decide if we possibly need to increase our monitoring post pregnancy. A second purpose is to find out if there is a need for continuing lovenox for a longer period post pregnancy.
I have done an extensive pubmed search for research that addresses my research issue. I have found none. I hope you can help.
DR
