From the Guidelines
Eliquis (apixaban) is not recommended during breastfeeding due to the potential risk of bleeding complications in the infant. The most recent and highest quality study, published in 2018 by the American Society of Hematology, found that there is very low certainty in evidence against using direct-acting oral anticoagulants, such as apixaban, while breastfeeding 1. This recommendation strongly valued avoiding adverse bleeding outcomes in infants of breastfeeding mothers.
Some key points to consider:
- The transfer of apixaban into breast milk is not well studied, but it is known that small amounts can pass into breast milk, potentially affecting the nursing infant.
- The main concern is the risk of bleeding complications in the infant, as Eliquis is a potent blood thinner that inhibits Factor Xa in the coagulation cascade.
- For breastfeeding mothers who require anticoagulation, heparin or low molecular weight heparin (such as enoxaparin) are often preferred alternatives because they have minimal transfer into breast milk due to their large molecular size and are poorly absorbed orally by the infant.
- A previous study published in 2012 by the American College of Chest Physicians also recommended alternative anticoagulants rather than oral direct thrombin and factor Xa inhibitors, such as apixaban, for breastfeeding women 1.
- Another study published in 2018 found that there were no direct data examining the effect of different treatments on neonatal bleeding, highlighting the need for more research in this area 1.
If you are currently taking Eliquis and breastfeeding or planning to breastfeed, it's essential to discuss this with your healthcare provider to determine the most appropriate anticoagulation strategy that balances your medical needs with the safety of your infant.
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 Safety: Apixaban is not recommended during breastfeeding due to unknown human exposure through milk.
- Key Points:
- No data on presence of apixaban in human milk
- Unknown effects on breastfed child or milk production
- Breastfeeding not recommended during treatment with apixaban tablets 2
From the Research
Safety of Eliquis (Apixaban) During Breastfeeding
- The safety of Eliquis (apixaban) during breastfeeding is not well-established, with limited data available 3.
- A narrative review of direct oral anticoagulant safety during breastfeeding found that apixaban has a greater milk excretion than the maximum allowed range, whereas rivaroxaban and dabigatran have acceptable milk excretion cutoffs 3.
- Another study found that rivaroxaban, a direct-acting oral anticoagulant, appears in human breast milk in small amounts, but its safety has not been determined 4.
- General guidelines for medication use during breastfeeding suggest choosing the safest drug available, consulting with the infant's pediatrician, and advising the mother to take the medication just after breastfeeding or before the infant's longest sleep period 5, 6.
- It is recommended to consult reliable sources and weigh the benefits of breastfeeding against the potential risk to the nursing infant when considering the use of any medication, including Eliquis (apixaban) 5, 6, 7.