Fraxiparine vs. Enaxoparin

Geneva Dreamin

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Reply Fraxiparine vs. Enaxoparin Posted on: Dec 18, 2010 at 1:05pm
Dear Dr. Braverman,

I suffered 2 miscarriages in the last year and have spent the last 6 months testing and getting my arsenal together to try again. I am in Switzeland and am working with an RE who I trust as having miscarriage experience, but who is not a specialist in miscarriage. With only hetero MTHFR, very slightly positive anticardiolipin antibodies, and a slightly irregular fundus as possible causes (most immune factors in the 'Chicago tests' were non-existent or marginal), I feel comfortable with proceeding with a regime of Metanx, low-molecular weight heparin treatment and progesterone for our next try.

My doctor has prescribed Fraxiparine instead of Enoxaparin (e.g. Lovenox or Clexane). In your opinion, is there any important difference between the two products which I should be worried about?

Thanks for your reply.

Carmen

Dr. Braverman

2024 Posts
Re: Fraxiparine vs. Enaxoparin Posted on: Dec 18, 2010 at 11:28pm
No not at all, sounds like you have a good plan . Im assuming you have also ruled out genetics , had a hysteroscopy , and looked at all male issues? Before embarking on the Fraxiparine therapy just make sure all else has been ruled out as the thrombophilic findings although present are not highly significant.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Geneva Dreamin

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Reply Re: Fraxiparine vs. Enaxoparin Posted on: Dec 19, 2010 at 12:03pm
Thanks for your reply. Without making this post too long -- my husband and I have done genetic counseling and I've had a hysteroscopy and endo biopsy. Aside from a slightly arched fundus, high resistance index in doppler ultrasound of uterine artery, and a slightly thin endometrium at 7mm, there are no other obvious issues. I think that Fraxiparine treatment is more for the anticardiolipin antibodies in the first trimester and because of the idea that low-mol weight heparin can help with the thickening of the endo if blood flow is my problem. I'm going to be doing acupuncture prior to ovulation to try to increase uterine blood flow, and then start the Fraxiparine after ovulation.

Sorry to beg the point, and this may seem like a silly question given your answer, but does Nadroparin work the same way as Enoxaparin (can I expect all the same benefits with Fraxiparine as you have listed on your site for Lovenox)?

Thanks again for your post. Just trying to work out some nervousness about our next try.

Dr. Braverman

2024 Posts
Re: Fraxiparine vs. Enaxoparin Posted on: Dec 20, 2010 at 2:11am
Yes you will have the same benefits. Might want to try Viagra 25mg 4 times a day , and Vit E 600 IU per day to help with the lining as well start with any stimulation protocol. If this does not work along with the lmw heparin feel free to call me and I can arrange futher detailed immune testing, but I think you have a great shot here.

Good Luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Geneva Dreamin

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Reply Re: Fraxiparine vs. Enaxoparin Posted on: Mar 31, 2011 at 9:49am
Hello again Dr. Braverman,

Thanks again for your replies to my earlier messages. I have a quick question about the recommended use of Vitamin E to improve endometrium thickness. Should one STOP vitamin E if pregnant?

There seems to be different viewpoints on the web about it and I thought I would ask.

Dr. Braverman

2024 Posts
Re: Fraxiparine vs. Enaxoparin Posted on: Apr 4, 2011 at 1:22am
Once pregnancy is confirmed we stop the additional Vit E.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Geneva Dreamin

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Reply Re: Fraxiparine vs. Enaxoparin Posted on: May 15, 2011 at 4:57pm
Well, I am very sad to say that I'm currently having my 2nd miscarriage (4th in total) on the protocol I mentioned at the end of last year: acupuncture, progesterone 200mg 3 x daily, Fraxiparine 0.3 once daily, metanx, along with preconception Vitamin E.

I'm at the end of my rope here in Geneva, so I will be submitting a new patient form to you and will seek a consultation with your office after I resolve this latest miscarriage and obtain my lab test results from my doctor here.

In the meantime, I was hoping that you could give me your opinion. These last two miscarriages have been very different than the first two. The first two early 2010 were both missed miscarriages, both discovered with no heartbeat at week 9, each resolved by D&C. My latest two have been very early after confirmation via hcg beta: strong bleeding at 4.5 weeks for the first, and now spotting at 5.5 weeks with hcg peaking at about 1400 and then falling. Also, this time around I woke up a few times in the early morning with mild cramping or strange sharp twingey feelings in my lower abdomen and I noticed heavier spotting these same mornings.

1) Could it be that my Fraxiparine dose was too low (especially since Fraxiparine duration of action is only 18 hours)? I am 170 lbs and I am taking 0.3 ml once daily at about 8AM. Most other ladies I have seen posting their treatments are having dosages twice daily.

2) Is there any 'rule of thumb' for determining whether a miscarriage is due to chromosomal problems without testing? In other words, since these miscarriages were so early, could it just be bad luck twice in a row?

3) The only diagnostic test I haven't had is a laparoscopy. I don't have any symptoms of endometriosis except for very obvious pain during ovulation. Is a laparoscopy something I should consider? That would be something I would need to do here in Geneva most likely.

4) I had a full RI test panel one year ago with Dr. Kwak's office in Chicago, with an aPL positive test later that summer. Most were negative, with very slightly high cytokine, tnf alpha and NK (by slightly, I mean .5 to 1 percentage points higher than reference). Do you feel it will be important for me to repeat these tests with your office?

As I mentioned, I don't believe there are any RI specialists or even recurrent miscarriage specialists here in Geneva, Switzerland. My RE is one of the best in town, but confesses that he is not an expert on miscarriage. So, I would definitely like to consult with you before proceeding.

Thanks in the meantime for your reply,

Carmen

Dr. Braverman

2024 Posts
Re: Fraxiparine vs. Enaxoparin Posted on: May 18, 2011 at 9:52pm
I am so sorry for your loss. Please call our office and ask for Kim she will assist you in arranging a consultation. Im sure we will figure this out for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.