Is Heparin compatible with breastfeeding? Do we have alternatives for Heparin?

Heparin

November 9, 2014 (Very Low Risk)

The high molecular weight of both standard or non-fractionated Heparin, and, so-called low molecular weight Heparin makes excretion into breast milk extremely difficult. Dalteparin has been shown not to be excreted into breast milk .

In addition, Heparins are inactivated in the GE tract where they are not absorbed which is reason to have a nil oral bioavailability.

Absence of anti-clotting activity in breastfed infants has been shown after treatment of the mother with Enoxaparin.

Risk of Heparin-induced Thrombocytopenia or Osteoporosis in the mother is lower with low weight Heparins.

Eleventh WHO Model List of Essential Drugs 2002: Compatible with breastfeeding.

Alternatives

We do not have alternatives for Heparin since it is relatively safe.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • ヘパリン
  • Heparin Calcium
  • Heparin Sodium
  • هيبارين
  • Ηπαρίνη
  • Гепарин
  • 肝素

Drug trade names

References

  1. Hospira NZ Limited. Heparin. Data Sheet. 2014 Full text (in our servers)
  2. Ozdemir D, Tam AA, Dirikoc A, Ersoy R, Cakir B. Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy. Osteoporos Int. 2014Abstract
  3. Fuller KP, Turner G, Polavarapu S, Prabulos AM. Guidelines for use of anticoagulation in pregnancy. Clin Lab Med. 2013Abstract
  4. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  5. Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012Abstract Full text (link to original source) Full text (in our servers)
  6. Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011Abstract Full text (link to original source) Full text (in our servers)
  7. Rath W. [Thromboprophylaxis during pregnancy and the puerperium: highlights from current guidelines]. Z Geburtshilfe Neonatol. 2010Abstract
  8. AEMPS. Heparina. Ficha técnica. 2009 Full text (in our servers)
  9. Lindhoff-Last E, Bauersachs R. Heparin-induced thrombocytopenia-alternative anticoagulation in pregnancy and lactation. Semin Thromb Hemost. 2002Abstract
  10. Wautrecht JC. [Which anticoagulants?]. Rev Med Brux. 2002Abstract
  11. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  12. Richter C, Sitzmann J, Lang P, Weitzel H, Huch A, Huch R. Excretion of low molecular weight heparin in human milk. Br J Clin Pharmacol. 2001Abstract Full text (link to original source) Full text (in our servers)
  13. Lindhoff-Last E, Willeke A, Thalhammer C, Nowak G, Bauersachs R. Hirudin treatment in a breastfeeding woman. Lancet. 2000Abstract
  14. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Arch Intern Med. 2000Abstract Full text (link to original source) Full text (in our servers)
  15. Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997Abstract
  16. Guillonneau M, de Crepy A, Aufrant C, Hurtaud-Roux MF, Jacqz-Aigrain E. [Breast-feeding is possible in case of maternal treatment with enoxaparin]. Arch Pediatr. 1996Abstract
  17. Kandrotas RJ. Heparin pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 1992Abstract
  18. Wunderer G, Müller G. [Osteoporosis and pre- and postpartal heparin therapy]. Geburtshilfe Frauenheilkd. 1990Abstract
  19. Ginsberg JS, Hirsh J. Optimum use of anticoagulants in pregnancy. Drugs. 1988Abstract
  20. Harenberg J, Leber G, Zimmermann R, Schmidt W. [Prevention of thromboembolism with low-molecular weight heparin in pregnancy]. Geburtshilfe Frauenheilkd. 1987Abstract
  21. Estes JW. Clinical pharmacokinetics of heparin. Clin Pharmacokinet. 1980Abstract