Direct oral anticoagulant safety during breastfeeding: a narrative review

Daei, Maryam; Khalili, Hossein; Heidari, Zinat

doi:10.1007/s00228-021-03154-5

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Postoperatively, the patient continued to have issues with hypoxia and hypercarbia. She was transitioned from heparin infusion to daily enoxaparin injections as she decided to breastfeed her baby [ 11 ]. The patient received daily enoxaparin injections as there is some evidence that oral anticoagulants might be excreted in breast milk [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Emergent Cesarean Delivery in a Patient With Freeman-Sheldon Syndrome Complicated by Preeclampsia, Acute Pulmonary Embolism, and Pulmonary Edema: A Case Report

Fayed¹,

Giska²,

Shievitz³

et al. 2021

Cureus

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Freeman-Sheldon syndrome (FSS) is an exceedingly rare congenital disorder with an unspecified prevalence. FSS is caused by a mutation in the embryonic skeletal muscle myosin heavy chain 3 gene. Patients may have facial abnormalities that put them at risk of difficult airway intubation. These facial abnormalities include micrognathia, macroglossia, high-arched palate, prominent forehead, and mid-face hypoplasia. Additionally, skeletal abnormalities such as joint contractures, scoliosis with resultant restrictive lung disease, and camptodactyly (bent fingers) can be noted. These features played an important role in the anesthetic management of our FSS patient. Perioperative planning and optimization were crucial in her anesthetic management as she underwent an urgent cesarean section due to preeclampsia with severe features.

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Section: Discussionmentioning

confidence: 99%

Emergent Cesarean Delivery in a Patient With Freeman-Sheldon Syndrome Complicated by Preeclampsia, Acute Pulmonary Embolism, and Pulmonary Edema: A Case Report

Fayed¹,

Giska²,

Shievitz³

et al. 2021

Cureus

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“…de). The use of DOACs during breastfeeding is not recommended, as the extent to which these substances or their metabolites pass into breast milk has not been sufficiently investigated [36].…”

Section: Strong Consensus 100%mentioning

confidence: 99%

New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline

Weimar,

Beyer-Westendorf,

Bohmann

et al. 2024

Neurol. Res. Pract.

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Over the last years, new evidence has accumulated on multiple aspects of diagnosis and management of cerebral venous and dural sinus thrombosis (CVT) including identification of new risk factors, studies on interventional treatment as well as treatment with direct oral anticoagulants. Based on the GRADE questions of the European Stroke Organization guideline on this topic, the new German guideline on CVT is a consensus between expert representatives of Austria, Germany and Switzerland. New recommendations include:• CVT occurring in the first weeks after SARS-CoV-2 vaccination with vector vaccines may be associated with severe thrombocytopenia, indicating the presence of a prothrombotic immunogenic cause (Vaccine-induced immune thrombotic thrombocytopenia; VITT).• D-dimer testing to rule out CVT cannot be recommended and should therefore not be routinely performed.• Thrombophilia screening is not generally recommended in patients with CVT. It should be considered in young patients, in spontaneous CVT, in recurrent thrombosis and/or in case of a positive family history of venous thromboembolism, and if a change in therapy results from a positive finding.• Patients with CVT should preferably be treated with low molecular weight heparine (LMWH) instead of unfractionated heparine in the acute phase.• On an individual basis, endovascular recanalization in a neurointerventional center may be considered for patients who deteriorate under adequate anticoagulation.• Despite the overall low level of evidence, surgical decompression should be performed in patients with CVT, parenchymal lesions (congestive edema and/or hemorrhage) and impending incarceration to prevent death.• Following the acute phase, oral anticoagulation with direct oral anticoagulants instead of vitamin K antagonists should be given for 3 to 12 months to enhance recanalization and prevent recurrent CVT as well as extracerebral venous thrombosis.• Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogen–progestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used.• Women with previous CVT and without contraindications should receive LMWH prophylaxis during pregnancy and for at least 6 weeks post partum.Although the level of evidence supporting these recommendations is mostly low, evidence from deep venous thrombosis as well as current clinical experience can justify the new recommendations.This article is an abridged translation of the German guideline, which is available online.

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“…Although the American College of Chest Physicians recommends avoiding DOACs during breastfeeding, 46 rivaroxaban and dabigatran have been used by breastfeeding mothers, with careful monitoring of infants for any signs of bleeding. 67 There are fewer data available on Low-dose mifepristone is available in many countries, though only higher dose formulations are available in the USA edoxaban use during breastfeeding, so it is not currently recommended. To better understand the risks associated with use of these medications, the International Society on Thrombosis and Haemostasis has a repository for clinicians to report cases of DOAC exposure during pregnancy and lactation.…”

Section: Breastfeeding While On Anticoagulationmentioning

confidence: 99%

Special Considerations for Women of Reproductive Age on Anticoagulation

Azenkot

Schwarz

2022

J GEN INTERN MED

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Anticoagulation poses unique challenges for women of reproductive age. Clinicians prescribing anticoagulants must counsel patients on issues ranging from menstruation and the possibility of developing a hemorrhagic ovarian cyst to teratogenic risks and safety with breastfeeding. Abnormal uterine bleeding affects up to 70% of young women who are treated with anticoagulation. As such, thoughtful clinical guidance is required to avoid having young women who are troubled by their menses, dose reduce, or prematurely discontinue their anticoagulation, leaving them at increased risk of recurrent thrombosis. Informed by a review of the medical literature, we present current recommendations for assisting patients requiring anticoagulation with menstrual management, prevention of hemorrhagic ovarian cysts, and avoiding unintended pregnancy. The subdermal implant may be considered a first-line option for those requiring anticoagulation, given its superior contraceptive effectiveness and ability to reliably reduce risk of hemorrhagic ovarian cysts. All progestin-only formulations—such as the subdermal implant, intrauterine device, injection, or pills—are generally preferred over combined hormonal pills, patch, or ring. Tranexamic acid, and in rare cases endometrial ablation, may also be useful in managing menorrhagia and dysmenorrhea. During pregnancy, enoxaparin remains the preferred anticoagulant and warfarin is contraindicated. Breastfeeding women may use warfarin, but direct oral anticoagulants are not recommended given their limited safety data. This practical guide for clinicians is designed to inform discussions of risks and benefits of anticoagulation therapy for women of reproductive age.

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Direct oral anticoagulant safety during breastfeeding: a narrative review

Cited by 12 publications

References 25 publications

Emergent Cesarean Delivery in a Patient With Freeman-Sheldon Syndrome Complicated by Preeclampsia, Acute Pulmonary Embolism, and Pulmonary Edema: A Case Report

Emergent Cesarean Delivery in a Patient With Freeman-Sheldon Syndrome Complicated by Preeclampsia, Acute Pulmonary Embolism, and Pulmonary Edema: A Case Report

New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline

Special Considerations for Women of Reproductive Age on Anticoagulation

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