Anticoagulants
IABLE

Anticoagulants

Warfarin, heparin, dalteparin, and enoxaparin are currently considered acceptable first-line agents during breastfeeding. A small amount of information indicates that the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitor rivaroxaban might be acceptable in nursing mothers because amounts excreted into milk are very small. They should be used with close monitoring of the infant for bruising or bleeding. Early data on apixaban indicates that substantial amounts are excreted into breastmilk and it should be avoided in nursing mothers.

The other oral anticoagulants and antiplatelet drugs have little or no documentation of either their passage into breast milk or their safety for the nursing infant, so they should be avoided during breastfeeding, if possible. However, physicochemical factors and clinical data indicate that some of them might prove to be safe. Low-dose (91 mg/day) aspirin is an acceptable anti-platelet drug.

References

  1. Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Adv 2018;2:3317-59. PMID: 30482767
  2. Daei M, Khalili H, Heidari Z. Direct oral anticoagulant safety during breastfeeding: A narrative review. Eur J Clin Pharmacol 2021. PMID: 33963877
  3. Datta P, Bramnik A, Rewers-Felkins K, et al. Transfer of apixaban into human milk. Obstet Gynecol 2021;137:1080-2. PMID: 33957661