From the Guidelines
It is not recommended to take Eliquis (apixaban) while breastfeeding due to the low certainty of evidence for its safety in this context. The American Society of Hematology 2018 guidelines for management of venous thromboembolism state that there is very low certainty in evidence against using direct-acting oral anticoagulants, such as apixaban, while breastfeeding 1. This recommendation strongly values avoiding adverse bleeding outcomes in infants of breastfeeding mothers.
Some key points to consider when making a decision about taking Eliquis while breastfeeding include:
- The potential risks of bleeding in the infant due to the transfer of apixaban in breast milk
- The lack of data on the safety of direct-acting oral anticoagulants in breastfeeding mothers
- The availability of alternative anticoagulants, such as heparin or low molecular weight heparin, which may be safer for use during breastfeeding
The American College of Chest Physicians also recommends alternative anticoagulants rather than oral direct thrombin and factor Xa inhibitors, such as apixaban, for breastfeeding women 1.
Given the potential risks and the lack of evidence on the safety of apixaban during breastfeeding, alternative medications like heparin or low molecular weight heparin are often preferred. It is essential to consult with a healthcare provider before making any decisions about medication while breastfeeding, as they can help weigh the specific risks and benefits in an individual situation and recommend the safest option for both the mother and the baby.
From the FDA Drug Label
There are no data on the presence of apixaban or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production. Because human exposure through milk is unknown, breastfeeding is not recommended during treatment with apixaban tablets
Breastfeeding is not recommended while taking Eliquis (apixaban) due to the unknown effects on the breastfed child and lack of data on the presence of apixaban in human milk 2.
From the Research
Safety of Eliquis (Apixaban) During Breastfeeding
- There are no direct studies on the safety of Eliquis (apixaban) during breastfeeding in the provided evidence.
- However, studies on similar anticoagulants, such as rivaroxaban, suggest that they can pass into human breast milk in small amounts 3.
- The general consensus is that most drugs are transferred from the mother's blood to the milk, but the breastfed infant usually ingests a small amount of the drug through human milk 4, 5, 6, 7.
- When prescribing medications for a breastfeeding patient, those with the lowest risk to the infant should be selected, and dosing should be before the infant's longest sleep interval 5.
- It is recommended to use current, accurate resources, such as LactMed, to determine the safety of medications during breastfeeding 5.
- The decision to use Eliquis (apixaban) during breastfeeding should be made on a case-by-case basis, taking into account the benefits of breastfeeding and the risks of untreated maternal disease 4.