From the Guidelines
Eliquis (apixaban) should not be given during pregnancy due to the potential risks to the fetus and the lack of sufficient safety data. The American College of Chest Physicians recommends avoiding the use of oral direct thrombin and anti-Xa inhibitors, including apixaban, in pregnant women [ 1 ]. This recommendation is based on the potential for these medications to cross the placenta and affect fetal development.
Alternative Anticoagulants
Instead, pregnant women can use alternative anticoagulants, such as low molecular weight heparins like enoxaparin, which have established safety profiles in pregnancy and do not cross the placenta [ 1 ]. Warfarin is also contraindicated during pregnancy, especially in the first trimester, due to the risk of birth defects.
Safety Concerns
The safety concerns associated with Eliquis during pregnancy are significant, and animal studies have shown reproductive toxicity [ 1 ]. If a woman becomes pregnant while taking Eliquis, she should contact her healthcare provider immediately to switch to a pregnancy-appropriate anticoagulant.
Breastfeeding Considerations
Additionally, women who are breastfeeding should avoid Eliquis as it may be excreted in breast milk [ 1 ]. Any transition between anticoagulants should be carefully managed by healthcare providers to ensure continuous protection against thrombosis while minimizing risks to the mother and fetus.
Key Points
- Eliquis is not recommended during pregnancy
- Alternative anticoagulants, such as low molecular weight heparins, are preferred
- Warfarin is contraindicated during pregnancy, especially in the first trimester
- Eliquis may cross the placenta and affect fetal development
- Breastfeeding women should avoid Eliquis due to potential excretion in breast milk
From the FDA Drug Label
Pregnancy: Not recommended. (8.1) The answer is no, Eliquis (apixaban) should not be given during pregnancy, as stated in the drug label 2.
From the Research
Eliquis (Apixaban) Use During Pregnancy
- There is limited evidence on the use of Eliquis (apixaban) during pregnancy, but one case report suggests it may be a viable option for anticoagulant therapy in pregnant women with a history of venous thromboembolic events and heparin-induced thrombocytopenia 3.
- In this case report, a pregnant woman with antithrombin deficiency and a history of heparin-induced thrombocytopenia was successfully treated with apixaban, with no progression of thrombus noted during the pregnancy and no adverse effects on the newborn baby 3.
- However, it is essential to note that this is a single case report, and more research is needed to fully understand the safety and efficacy of apixaban during pregnancy.
- Other anticoagulant options, such as low molecular weight heparins (LMWHs), are commonly used during pregnancy and are considered safe and effective 4, 5, 6.
- The use of apixaban during pregnancy should be carefully considered and individualized to each patient's specific needs and medical history, as there is currently limited evidence to support its use in this population.