The Warfarin Syndrome

Patient Expert

Despite the rain here in West Virginia, Halloween brought out dozens of trick-or-treaters to my neighborhood. There were skeletons, princesses and super heroes galore. I also had the occasional older kid who didn't dress up, but hey, he was going door to door in the rain, so I gave him a piece of gum. But the little ones were so adorable. My son, while adorable in his own way, was a demented looking clown. He's 12, though, so I expected something like that. Kids are great though, so great; I would love to have more.

My history of stroke scares me, though. It's been several years since my husband and I entertained the thought of having a baby. But, we're getting the bug again, so we went to a high-risk OB-GYN. The main thing I have to do is to get off my Coumadin and begin Lovenox. Lovenox is an anticoagulant (blood thinner) that is injected, rather than taken orally. I'm not crazy about needles and since my doctor wants me fully medicated, I would have to endure two shots a day. But, from what my doctor told me, it's the best way to prevent a blood clot during pregnancy. Plus, the drug is in the FDA pregnancy category B. This means that it is not expected to be harmful to an unborn baby.

Initially, my doctors all agreed that I should not be on my Coumadin when I got pregnant because the medication could cause birth defects. Then, a year later, they (same doctors) told me that the dangers of Coumadin are found later in the pregnancy and that my baby would be fine, even if I was on Coumadin at conception. Once I get pregnant, then I could switch to the Lovenox shots. But mild deformities and skeletal problems don't sound fine to me.

Warfarin or Coumadin is an anticoagulant used by patients with artificial heart valves or people like me, who have had a stroke and need to prevent further blood clots. But the drug has a primary teratogenic effect. A teratogen is an agent that can disturb the development of the embryo or fetus, even in the early stages of pregnancy. Teratogen can halt the pregnancy or permit the pregnancy to proceed but produce a congenital malformation (a birth defect). The primary affect is in the fetus' axial and appendicular skeleton. Effected children also have a hypoplastic nose, eye abnormalities, mental retardation and scoliosis. These conditions are known as Warfarin Syndrome.

The best bet is to get on the Lovenox shots prior to conception. But a lot of insurance companies won't cover the Lovenox when used pre-conceptually. I believe mine will, which is good, because the last time I priced it, it was going to cost me about $1,000 per month. That is pretty pricey, especially when you never know how long it will take to get pregnant. Since it is covered for me, I would say it's worth it. I would hate to think I could have prevented my baby from deformities by putting up with the shots while I was trying to get pregnant. But, I still haven't made up my mind. Stay tuned.