# Tinzaparin Anyone else on it?



## hawalkden

I had a blood clot in my lung in March 2010 and was on warfarin for 6 months. I had my son 7 months ago and had to take Tinzaparin due to the risk of the clot. I wasn't good at taking it and now I'm pregnant again :). 14 weeks and been supplied with Tinzaparin again throughout this pregnancy and I need to have tips and support to make the whole 7-8pm ordeal of taking it every night miles eaiser. 
At the moment. OH gives it to me and doesn't pressure me and then gives me lots of support but I hate it every night.
Thanks in advance.


----------



## petitpas

Hiya :hi:
I'm on fragmin (different brand to the tinz, which I am going back on next week). Before my clot diagnosis I used to be a needle-phobe, now I prefer to do the shots myself.
This way I can go super slowly and even briefly stop so that it doesn't sting. I don't think I could ever let anyone else do it for me anymore - ouch!

There are quite a few ladies on various forms of low molecular weight heparin during pregnancy, mainly due to previous miscarriages. The most common brands are clexane or lovenox. If you do a search on those words you'll find a lot of ladies here to join you through your pregnancy.

The biggest hurdle is doing it by yourself for the first time. I was petrified and it took me a long time. Then, when I did try I was surprised at how easy it was :dohh:

You can do it! Just take the time and you know when you will be ready :hugs:
In the meantime, make sure your hubby injects the liquid as S L O W L Y as possible :winkwink:


----------



## Trissy

I was on Tinzaparin for a week and then warfarin for 6 months for DVT and PE in 2008. My hematologist said for pregnancy I'll need to go on LMWH and I go Wednesday to find out if I'll need LMWH for the entirety of the pregnancy or just the last 4 weeks of pregnancy and 6-8 weeks postpartum. 

I honestly would feel safer being on the blood thinners for the whole pregnancy so I'm really going to push for them. With my clots in 2008 it took 11 days to finally be diagnosed from when I first went to emergency complaining of symptoms. At that point I had bilateral PE. If they would have listened to me in the beginning I may have been able to avoid the clot in my leg breaking off. I really don't want to have to worry about that while pregnant. 

I never had an issue giving myself the shots but ooohhh did I hate the tenderness and awful bruising that they caused.


----------



## hawalkden

Thanks ladies :). OH just goes slow putting it in and fast with the liquid. I'm getting loads of bruises and pains a few days after. Darn Warfrin should be made to have during pregnancies.! I know I should man up due to being a Diabetic and the injections I have! Urgh!
Hope I get better with it :)x


----------



## lizlemon

I am new to the whole jab thing and find it v painful, but today I tried 2 things which seemed to help. 1) make sure on drips on needle before 2) put liquid in really slowly! Tomorrow I am going to try ice on area after injection.

Good luck xxxx


----------



## petitpas

Trissy said:


> I was on Tinzaparin for a week and then warfarin for 6 months for DVT and PE in 2008. My hematologist said for pregnancy I'll need to go on LMWH and I go Wednesday to find out if I'll need LMWH for the entirety of the pregnancy or just the last 4 weeks of pregnancy and 6-8 weeks postpartum.
> 
> I honestly would feel safer being on the blood thinners for the whole pregnancy so I'm really going to push for them. With my clots in 2008 it took 11 days to finally be diagnosed from when I first went to emergency complaining of symptoms. At that point I had bilateral PE. If they would have listened to me in the beginning I may have been able to avoid the clot in my leg breaking off. I really don't want to have to worry about that while pregnant.
> 
> I never had an issue giving myself the shots but ooohhh did I hate the tenderness and awful bruising that they caused.

Hi Trissy, after a DVT - actually, especially a PE! - you should definitely be on LMWH for the duration of pregnancy and for six weeks afterwards. If any doctor says otherwise, fight! It should be in the Canadian guidelines, though. Sorry, I am not familiar with them otherwise I would point you in the right direction.



hawalkden said:


> Thanks ladies :). OH just goes slow putting it in and *fast with the liquid*. I'm getting loads of bruises and pains a few days after. Darn Warfrin should be made to have during pregnancies.! I know I should man up due to being a Diabetic and the injections I have! Urgh!
> Hope I get better with it :)x

Fast with the liquid? Did I read that correctly? OOOOOOUUUUUUCH!
It's the liquid that stings so please ask him to go as slowly as possible (30-60 seconds, easily).


----------



## hawalkden

oh the sting for me doesnt hurt as much if it just goes in fast. slow makes the whole event drama for me :|


----------



## Trissy

petitpas said:


> Hi Trissy, after a DVT - actually, especially a PE! - you should definitely be on LMWH for the duration of pregnancy and for six weeks afterwards. If any doctor says otherwise, fight! It should be in the Canadian guidelines, though. Sorry, I am not familiar with them otherwise I would point you in the right direction.

Thanks for the reassurance that I'm not paranoid and I really should be on LMWH for the whole pregnancy. I am going to insist on the blood thinners when I go in for my first prenatal appointment Wednesday. As I'm not technically a patient yet of her practice, I suppose they have the right to turn me away, but I really hope she'll listen to my history and fears about this. Not being on anything right now is making it hard to sleep for the fear of getting another clot. Every little leg pain has me on edge. The doctor I saw for my referral to the OB said that unless symptomatic she wouldn't put me on blood thinners, so I left there empty handed. The more I've read about it though, and just from what the hematologist said, I really want to go back on them as soon as possible. I'm terrified of having a clot that breaks off and does something to the baby and having no way of knowing, or another PE. It's keeping me up at night.


----------



## petitpas

Trissy, do they know what caused your clots? Was it the pill?
With me, they blamed the pill and that automatically put me at higher risk in pregnancy as the same hormones are at play.

I've had a quick google and found the Society of Obstetricians and Gynaecologists of Canada. Under the Clinical Practice Guidelines (I had to do a search for 'thromboembolism' to find it) was the following document:
https://www.sogc.org/guidelines/public/95E-CPG-September2000.pdf
It's a bit 'old' as it dates from 2000 and a lot of research has been carried out since then but nonetheless on page 3 you will find that the suggested treatment for a woman with previous VTE but not on lifelong anticoagulation is with heparin. It starts talking about unfractioned heparin, which I believe is a bit outdated as this method is hardly used anymore, but also mentions the dosages of LMWH, specifically dalteparin (also known as fragmin).

As I said, I don't know the Canadian system but I am hoping this is the equivalent to our Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk) who set the guidelines in the UK:

https://www.rcog.org.uk/womens-health/clinical-guidance/reducing-risk-of-thrombosis-greentop37a in case you fancy reading it.

My suggestion would be to print out the guidelines (check that I have picked out the most current and applicable guidelines), highlight the paragraph and take it with you when you see your doctor. As even the dosage is marked on there they won't have to worry about getting it right (many family doctors shy away from LMWH as they aren't sure about the dosage and management). Hopefully, you will be referred to a consultant obstetrician who will be able to take it from there and manage your medication right through your pregnancy, delivery and beyond.

Good luck!


----------



## petitpas

Hawa, don't you get a nasty aftersting? If not, hats off as you are hard as nails :howdy:


----------



## Trissy

petitpas said:


> Trissy, do they know what caused your clots? Was it the pill?
> With me, they blamed the pill and that automatically put me at higher risk in pregnancy as the same hormones are at play.
> 
> I've had a quick google and found the Society of Obstetricians and Gynaecologists of Canada. Under the Clinical Practice Guidelines (I had to do a search for 'thromboembolism' to find it) was the following document:
> https://www.sogc.org/guidelines/public/95E-CPG-September2000.pdf
> It's a bit 'old' as it dates from 2000 and a lot of research has been carried out since then but nonetheless on page 3 you will find that the suggested treatment for a woman with previous VTE but not on lifelong anticoagulation is with heparin. It starts talking about unfractioned heparin, which I believe is a bit outdated as this method is hardly used anymore, but also mentions the dosages of LMWH, specifically dalteparin (also known as fragmin).
> 
> As I said, I don't know the Canadian system but I am hoping this is the equivalent to our Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk) who set the guidelines in the UK:
> 
> https://www.rcog.org.uk/womens-health/clinical-guidance/reducing-risk-of-thrombosis-greentop37a in case you fancy reading it.
> 
> My suggestion would be to print out the guidelines (check that I have picked out the most current and applicable guidelines), highlight the paragraph and take it with you when you see your doctor. As even the dosage is marked on there they won't have to worry about getting it right (many family doctors shy away from LMWH as they aren't sure about the dosage and management). Hopefully, you will be referred to a consultant obstetrician who will be able to take it from there and manage your medication right through your pregnancy, delivery and beyond.
> 
> Good luck!

They can't say 100% conclusively what caused it but after doing all of the genetic screening (I do have a strong family history of clotting disorders including FVL and activated Protein C resistancy) and ruling all of those out the hematologist concluded it was a combination of the pill and being mobidly obese. 

I had been put on a modified dose of the pill as I had a two year long period. I was on three pills a day for three days, two pills a day for three days and then one pill a day for three days. By the end of the second day I knew I had a blood clot in my leg. The pain was horrible. I didn't have any other symptoms (swelling, discoloration, etc.) so the doctors wouldn't even send me for a scan until 11 days later when I was having severe shortness of breath and chest pain. At that point I could barely walk from the pain. I over compensated with my other leg because I couldn't handle putting any weight on the clot leg and screwed up my right hip because of it. 

I really appreciate the information you dug up. I will definitely print out info to bring with me to my appt, with my giant list of questions that I already have. I emphasized to the first doctor I saw that I have a history of DVT/PE caused by the pill and she still said it wouldn't be necessary to go on blood thinners through the whole pregnancy which just seems... not right, to me. 

Thank you so much. :)


----------



## petitpas

No problem, Trissy, I hope it works out!

What a story, btw. Symptoms from day four of being on the pill seems pretty convincing that hormones had something to do with it.

I was tri-cycling the pill when I was diagnosed (three months at a time with no break) and I also have FVL (only heterozygous, though). My mum suffered a pregnancy-induced dvt...


----------



## Trissy

petitpas said:


> No problem, Trissy, I hope it works out!
> 
> What a story, btw. Symptoms from day four of being on the pill seems pretty convincing that hormones had something to do with it.
> 
> I was tri-cycling the pill when I was diagnosed (three months at a time with no break) and I also have FVL (only heterozygous, though). My mum suffered a pregnancy-induced dvt...

Well I pushed for bloodthinners and they put me on prophylaxis Fragmin and I developed a DVT on that. :(

Now on treatment dose of Tinzaparin for the next six months then back on Fragmin just in time to deliver which has me a little freaked out, since isn't that the most likely time to clot?? Right after delivery??

I really don't want to come off treatment dose, clot again, and then go back on treatment dose. 

This is sooooo frustrating!!!


----------



## petitpas

Trissy, that's scary :hugs: I ended up having a planned section and my haematology team were really pleased with that as they could plan my fragmin around it.
I had my last shot just over 24 hours before the surgery and then had my next six hours post-op. I was on a dose very similar to the treatment one but taking two shots a day.
Do you have a haematologist in charge of your care? If not, it is definitely worth asking to see one, especially if you can find one with an interest in clotting.


----------



## Trissy

I'll be seeing a group of internists who specialize in medical disorders in pregnancy and one of the most common disorders they see at their clinic are clotting disorders in pregnant women. I meet with them this coming Wednesday so I'm anxious to see where we go from here.

My doctor said that I'll more than likely have a vaginal birth, but I've read so many women on anticoagulation therapy have to have c-sections so it will be interesting to see what these doctors say.


----------



## petitpas

Trissy, I've never heard of anyone having to have a section purely for being on anticoagulants.
I think it is due to the underlying reasons such as antiphospholipid syndrome (higher chance of baby distress during labour), higher risk of pre-eclampsia etc.

Good luck with your appointment! They sound like the right doctors to be seing :thumbup:


----------

