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Direct oral anticoagulant safety during breastfeeding: a narrative review

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Abstract

Purpose

There are limited data regarding the safety of direct oral anticoagulants (DOACs) during breastfeeding. The aim of the present study is to investigate the extent of excretion of DOACs into human milk according to the available clinical and experimental studies.

Methods

On 16th January 2021, we systematically searched PubMed, Scopus, Embase, and Web of Science for all studies which investigated DOACs in breastfeeding without any time frame and language limitation. Search keywords were [breastfeeding, breast feeding, breastfed, lactation, milk secretion OR milk] AND [apixaban OR Eliquist OR rivaroxaban OR Xarelto OR edoxaban OR Savaysa OR dabigatran OR Pradaxa OR dabigatran etexilate OR dabigatran etexilate mesylate OR direct oral anticoagulant OR DOAC OR new oral anticoagulant OR NOAC]. Finally, we identified six articles which reported DOAC use during breastfeeding or lactation.

Results and conclusion

According to the available limited data, dabigatran has the least excretion in human breast milk. Rivaroxaban and dabigatran both have acceptable milk excretion cutoffs, whereas apixaban milk excretion is greater than the maximum allowed range. Further well-designed studies with larger sample sizes are required to generate consistent comparable data and clarify benefits and risks of each DOAC during breastfeeding.

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Availability of data and material

Data analyzed in this study were a reanalysis of existing data, which are openly available at locations cited in the reference section.

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Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Alborz University of Medical Sciences, Alborz, Iran

    Maryam Daei

  2. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Hossein Khalili

  3. Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

    Zinat Heidari

Authors
  1. Maryam Daei
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  2. Hossein Khalili
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  3. Zinat Heidari
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Contributions

All authors contributed to the study conception and design. The literature search and data analysis were performed by Maryam Daei and Zinat Heidari. The first draft of the manuscript was written by Maryam Daei and Zinat Heidari and Hossein Khalili revised it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zinat Heidari.

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Conflict of interest

The authors declare no competing interests.

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Daei, M., Khalili, H. & Heidari, Z. Direct oral anticoagulant safety during breastfeeding: a narrative review. Eur J Clin Pharmacol 77, 1465–1471 (2021). https://doi.org/10.1007/s00228-021-03154-5

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  • DOI: https://doi.org/10.1007/s00228-021-03154-5

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