Use of Antithrombotic Agents During Pregnancy: Use of Anticoagulants in the Nursing Mother
Heparin is not secreted in breast milk and can be administered safely to nursing mothers. There have been two convincing reports that warfarin does not induce an anticoagulant effect in the breast-fed infant when the drug is administered to a nursing mother Therefore, the use of warfarin in women who require postpartum anticoagulant therapy is reasonable; these women should be encouraged to breast feed.
LMWHs and Heparinoids
There is accumulating experience with the use of these agents both in pregnant and nonpregnant patients for the prevention and treatment of DVT. Based on the results of large clinical trials in nonpregnant patients, LMWH and heparinoids are at least as effective and safe as unfractionated heparin for the treatment of patients with acute proximal DVT and for the prevention of DVT in patients who undergo surgery. LMWHs have the advantage of a longer plasma half-life and a more predictable dose response than unfractionated heparin.
There is also evidence that LMWH and heparinoids do not cross the placenta add comment buy dexone online. These agents have potential advantages over unfractionated heparin during pregnancy because they cause less heparin-induced thrombocytopenia (HIT), have the potential for once-daily administration, and may result in a lower risk of heparin-induced osteoporosis. In pregnant women who develop HIT and require ongoing anticoagulant therapy, use of the heparinoid danaparoid (Orgaran) is recommended because it is an effective antithrombotic agent and has much less crossreactivity with unfractionated heparin and, therefore, less potential to produce recurrent HIT than LMWH. LMWHs are more expensive than unfractionated heparin and, therefore, until clinical trials, comparing their efficacy and safety with those of unfractionated heparin are performed, there is insufficient evidence to endorse them for routine clinical use in pregnant patients who require anticoagulant therapy. In addition, although monitoring of LMWH is not required for treatment of nonpregnant patients with acute VTE, there is no good information on appropriate dosing of LMWH in pregnant women with acute VTE. Danaparoid should be used in pregnant patients with HIT, and LMWH should be considered in patients with intractable painful skin reactions to unfractionated heparin and in those with osteopenia.