From the Research
When consulting with a fetal medicine doctor about Lovenox (enoxaparin) therapy following a stroke related to a patent foramen ovale (PFO) during pregnancy, it is crucial to ask specific questions about dosing, monitoring, and duration of treatment, as the most recent study 1 emphasizes the importance of collaboration and shared decision making in managing patients with PFO and stroke. Important questions to ask include:
- What is the appropriate Lovenox dose for my specific situation (typically 1mg/kg twice daily or 1.5mg/kg once daily)?
- How will my anti-Xa levels be monitored, and how frequently should testing occur (usually aiming for levels of 0.6-1.0 IU/mL for twice-daily dosing)?
- How long will I need to continue Lovenox therapy during pregnancy and postpartum (typically throughout pregnancy and for 6-12 weeks postpartum)? Ask about the timing of injections, potential side effects like bruising or bleeding, and whether dose adjustments might be needed as your pregnancy progresses and your weight changes. Also, inquire about the plan for transitioning off Lovenox before delivery to minimize bleeding risk during labor, typically stopping 24 hours before planned delivery or induction. These questions are crucial because pregnancy creates a hypercoagulable state that, combined with your PFO and recent stroke, requires careful anticoagulation management to prevent further clotting events while protecting both you and your developing baby, as highlighted in the study 2 which shows that anticoagulation confers no net benefit in recurrent stroke prevention over antiplatelets in patients with PFO-related stroke. However, the study 3 suggests that there is a benefit to closure, and the study 4 reviews the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines. The study 5 provides insight into the complications and clinical outcomes related to PFOs during pregnancy, and highlights the importance of careful management to prevent further clotting events. Overall, the management of patients with PFO and stroke during pregnancy requires careful consideration of the risks and benefits of different treatment options, and close collaboration between fetal medicine doctors and other healthcare providers, as emphasized in the study 1.