Faculty of Pharmacy, Alborz University of Medical Sciences, Alborz, Iran.
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Clin Pharmacol. 2021 Oct;77(10):1465-1471. doi: 10.1007/s00228-021-03154-5. Epub 2021 May 8.
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.
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.
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.
关于哺乳期直接口服抗凝剂（DOACs）的安全性，目前数据有限。本研究旨在根据现有临床和实验研究，调查 DOACs 排入人乳的程度。
2021 年 1 月 16 日，我们系统地在 PubMed、Scopus、Embase 和 Web of Science 上搜索了所有没有时间限制和语言限制的关于哺乳期使用 DOACs 的研究。搜索关键词为 [母乳喂养、哺乳、母乳喂养、泌乳、乳汁分泌或乳汁] AND [阿哌沙班或 Eliquis 或利伐沙班或 Xarelto 或依度沙班或 Savaysa 或达比加群或 Pradaxa 或达比加群酯或达比加群酯甲磺酸盐或直接口服抗凝剂或 DOAC 或新型口服抗凝剂或 NOAC]。最后，我们确定了六篇报告哺乳期或哺乳期使用 DOAC 的文章。
根据现有有限的数据，达比加群在人乳中的排泄最少。利伐沙班和达比加群的乳汁排泄截断值都可以接受，而阿哌沙班的乳汁排泄量大于允许的最大值。需要进一步设计良好、样本量更大的研究，以产生一致的可比数据，并阐明每种 DOAC 在哺乳期的益处和风险。
