From the Guidelines
Eliquis (apixaban) is contraindicated in pregnancy due to concerns about its safety and potential risks to the developing fetus. Pregnant women should avoid apixaban as there is insufficient data on its safety during pregnancy, and it may pose risks to the developing fetus [ 1 ]. The medication crosses the placental barrier, and animal studies have shown reproductive toxicity at high doses. For pregnant women requiring anticoagulation, low molecular weight heparins (LMWHs) like enoxaparin are the preferred option because they do not cross the placenta and have a well-established safety profile in pregnancy [ 2 ].
Some key points to consider:
- Direct oral anticoagulants, including apixaban, are not recommended during pregnancy due to concerns about safety [ 1 ].
- An accidental exposure to apixaban during pregnancy should not lead to a recommendation for termination of the pregnancy [ 1 ].
- Women of childbearing potential who are prescribed Eliquis should use effective contraception during treatment and inform their healthcare provider if planning pregnancy to discuss appropriate anticoagulation options.
- If you are currently taking Eliquis and discover you are pregnant, contact your healthcare provider immediately to discuss switching to a safer alternative [ 3 ].
- Do not stop taking anticoagulation suddenly without medical guidance, as this could increase your risk of blood clots.
From the FDA Drug Label
The limited available data on apixaban tablets use in pregnant women are insufficient to inform drug-associated risks of major birth defects, miscarriage, or adverse developmental outcomes. Treatment may increase the risk of bleeding during pregnancy and delivery
The FDA drug label does not explicitly state that Eliquis (apixaban) is contraindicated in pregnancy, but it does indicate that treatment may increase the risk of bleeding during pregnancy and delivery, and that the limited available data are insufficient to inform drug-associated risks of major birth defects, miscarriage, or adverse developmental outcomes 4.
- Key points:
- Insufficient data to inform drug-associated risks
- Increased risk of bleeding during pregnancy and delivery
- No explicit contraindication in pregnancy, but use with caution due to potential risks.
From the Research
Eliquis (Apixaban) in Pregnancy
- Eliquis, also known as apixaban, is a direct oral anticoagulant (DOAC) used to prevent and treat blood clots.
- The use of DOACs, including apixaban, during pregnancy is a topic of interest due to the potential risks and benefits associated with their use.
- According to a systematic literature review 5, there is limited evidence regarding the efficacy and safety of DOACs during pregnancy, with only 236 cases of DOAC use during pregnancy reported.
Safety and Efficacy of Apixaban in Pregnancy
- The review found that apixaban was not the most commonly reported DOAC, with rivaroxaban being the most reported 5.
- The majority of cases involved the use of DOACs for prophylaxis or treatment of venous thromboembolism, with most cases discontinuing DOAC use within the first 2 months of pregnancy 5.
- Pregnancy outcome data were available for 140 pregnancies, with a total miscarriage rate of 31% and live birth rate of 68% 5.
- Foetal and neonatal abnormalities were reported in 8 pregnancies, with at least half suspected to be related to rivaroxaban use during the 1st trimester of pregnancy 5.
Contraindications and Precautions
- While there is limited evidence on the use of apixaban during pregnancy, the available data raise concerns regarding embryo-foetal safety, with a high incidence of miscarriages and a 4% rate of anomalies with the use of rivaroxaban 5.
- The use of DOACs, including apixaban, during pregnancy should be approached with caution, and alternative anticoagulants such as low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) may be considered 6, 7, 8.