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leo

Pregnancy: Breastfeeding and Warfarin

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leo    0

Hi,

Does anyone know the dangers of taking warfarin postnatally and breastfeeding?? In my opinion, I think it is unsafe......

Ciao

Leo

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katybops    0

I thought I'd read it was safe unless taken in very large quantities?

I had assumed I'd be going onto it once I gave birth but because they only want me anticoagulated for 6 wks post partum I'm continuing with the shots. Otherwise they'd have switched me.

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JenniferD    0

It is safe to take warfarin while breastfeeding.

http://www.fvleiden.org/ask/30.html

Warfarin (Coumadin) is not detectable in the breast milk of mothers who take warfarin (coumadin). It is therefore safe to take in the breast-feeding woman. Since only a limited number of women on warfarin have been studied, these data can not exclude occasional passage of small amounts of warfarin into breast milk, but such doses are unlikely to cause bleeding in the newborn. However, it may be prudent to check coagulation studies in the newborn at risk for vitamin K deficiency, such as the premature born baby, before advising breast-feeding to mothers taking warfarin (coumadin).
My personal note: Most medications have not been studied in great numbers on nursing moms as no one who didn't abosultely need a medication is going to agree to experiement w/their breast milk!

http://www.parentsplace.com/expert/lactati..._106250,00.html

Coumadin (warfarin) is also an anticoagulant. The American Academy of Pediatrics considers this medication to be compatible with breastfeeding. Because of its high protein binding in the maternal circulation, very small amounts are secreted into breastmilk.

In three studies regarding the use of this drug in nursing mothers, no warfarin was found in any of the mother's milk, or in the infant's serum (with maternal warfarin doses ranging from 2 to 12 mg. per day). (Briggs 1990) Another study found very small amounts of this drug in mother's milk, but concluded that it posed little risk to the nursing baby.

(Emphasis mine)

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I have mixed feelings about this. I will breast feed again but my daugter did get some of the coumadin when I was breast feeding her. The doctor and I noticed it at her 2 month well baby when she had her shots. I was taking high doses of coumadin because my body would not 'regulate' it very well. I wasn't getting theraputic. She was also born early so those might have added to it. I'm not sure why it happend, but there is that small chance. She is perfectly fine though and it wasn't a dangerous bleeding situation. She was just a little on the thin side.

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JenniferD    0

My first quote did say premature babies may need to have their coagulation level checked. And I believe further details on one of those sites says there may be a greater risk of it passing through breastmilk with high doses of Warfarin/coumadin. But it was still a small amount and, as you discovered, serious risks to the child were very minimal.

I'm not saying this to push the drug. Just to say that if anyone was doubting their doctor's advice that Warfarin was okay, here's some more information aboout medical studies, etc. I just makes me uncomfortable to see personal experiences or opinions possibly take the place of a bit of research into what medical professionals have to say. I think we help each other most when we share our experience and provide hard facts we can take to our doctors for further clarity.

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katybops    0

It also might be worthwhile discussing how long you are supposed to take anticoagulants post partum. Warfarin is notoriously difficult to regulate, it took me (for example only) 8 months last time before they got me stable on it and my doses were all over the place. Plus just about everything interacts with it in terms of other medications! That's why if you're only going to be anticoagulated for a short time after the birth, it might be worth talking about continuing with the shots?

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My doctors always advised against it. I thought it was ridiculous. I am glad I breast fed her anyway. If there is any sort of problem at all you will notice it. The chances are very rare. I will breast feed again this time. This time I will be on lovenox and I think the molecules in it are too big to even pass through the breast milk. But, even if I was on coumadin I would still breast feed again. You know your body and you know your baby.

The only reason I have mixed feelings is because so many people say different things. You just have to do what is best for your family after you read the medical information.

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orangefoot    0

A personal note:

I have breastfed two children whilst taking Warfarin. With the first I was only taking it for 6 weeks post partum. With the second I took it post partum for 6 weeks, then 12 months post DVT whilst still breast-feeding. During this time I have also taken Heparin and Fragmin in prophylactic and therapeutic doses.

On all these occasions my GP, midwives DVT nurses and haematologist have been aware that I was breastfeeding. In fact I have breast-fed my daughter at 12 and 18 months in the haematologists consulting room. At no time was I advised against breast-feeding whilst taking Warfarin. In fact I was assured that it was not contraindicated and that it was not known to cause any problems. Neither my son nor my daughter have had any episodes of bleeding.

In my experience and anecdotally there is much ignorance among doctors as to which drugs can and cannot be taken whilst breast-feeding. Most tend to err on the side of 'caution' and advise against it.

In my opinion the benefits of breast-feeding far outweigh the small risk of bleeding from ingestion of a very small amount of Warfarin through breast-milk.

Perhaps Leo is thinking of the danger to the foetus during pregnancy from taking Warfarin. This however is not a bleeding risk but the fact that is is known to be teratogenic and interfers with normal development. There is no such effect for the full term child.

The decision whether to breast-feed your child or not can be based on many factors, but I would not count Warfarin among them. Ultimately, Breast is Best.

Rachel

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James    0
http://www.fvleiden.org/ask/30.html
However, it may be prudent to check coagulation studies in the newborn at risk for vitamin K deficiency, such as the premature born baby, before advising breast-feeding to mothers taking warfarin (coumadin).

I think the issue of the Vitamin K booster given to babies at birth is a bigger issue.

http://www.protein.org.uk/forum/index.php?showtopic=600

If there is a small amount of warfarin that gets through into breast milk and if it is active and if it affects the coagulation of the baby... how much of an increase in the INR are we talking? Besides, having a raised INR isn't a problem in itself, unless there is a bleeding problem. I really don't think it is worth worrying about but part of being a parent is the freedom to make choices for your own children and if you are in doubt then it is a personal decision and no-one can criticise you for it.

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leo    0

Thanks for all your points.

When I asked my consultant about the risks of breast feeding whilst taking warfarin, he did think it best to continue the delightful Clexane shots.

It is a decision I will have to make nearer the time. I know it is extremely difficult to regulate Warfarin. In the 3 months I took it last year, I think only one of my blood tests showed that I was at the right level. My INR at one point was over 6, and I had a scary bleed for 24 hours.

I will just have to see how early I will have to be induced and the health of myself and my baby at that time.

Cheers

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JenniferD    0

I've posted this in another thread, but here's some of what I found about the safety of taking warfarin while breastfeeding.

http://www.fvleiden.org/ask/30.html

QUOTE

Warfarin (Coumadin) is not detectable in the breast milk of mothers who take warfarin (coumadin). It is therefore safe to take in the breast-feeding woman. Since only a limited number of women on warfarin have been studied, these data can not exclude occasional passage of small amounts of warfarin into breast milk, but such doses are unlikely to cause bleeding in the newborn. However, it may be prudent to check coagulation studies in the newborn at risk for vitamin K deficiency, such as the premature born baby, before advising breast-feeding to mothers taking warfarin (coumadin).

My personal note: Most medications have not been studied in great numbers on nursing moms as no one who didn't abosultely need a medication is going to agree to experiement w/their breast milk!

http://www.parentsplace.com/expert/lactati..._106250,00.html

QUOTE

Coumadin (warfarin) is also an anticoagulant. The American Academy of Pediatrics considers this medication to be compatible with breastfeeding. Because of its high protein binding in the maternal circulation, very small amounts are secreted into breastmilk.

In three studies regarding the use of this drug in nursing mothers, no warfarin was found in any of the mother's milk, or in the infant's serum (with maternal warfarin doses ranging from 2 to 12 mg. per day). (Briggs 1990) Another study found very small amounts of this drug in mother's milk, but concluded that it posed little risk to the nursing baby.

(Emphasis mine)

Another poster noted that if one only needs anti-cogalulation for a brief post-pertum period one should talk to their doctor about the practicality of taking Warfarin as it often takes 6 weeks or more to fine-tune the doseage and requires frequent blood testing.

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orangefoot    0

Here are a few references for the safe use of Warfarin during lactation. I haven't been able to find any more recent than 2002, but I believe that as Warfarin is an old established drug this is not a significant problem.

Three general refereces and drug tables.

1 American Academy of Pediatrics

http://aappolicy.aappublications.org/cgi/c...trics;108/3/776

2 World Health Organisation

http://www.who.int/child-adolescent-health..._Medication.pdf

3 UK Medicines Information Service

http://www.ukmicentral.nhs.uk/drugpreg/guide.htm

QUOTE

Anticoagulants:

Heparins (unfractionated and low molecular weight) are considered 'safe' since these agents have a large molecular weight and do not cross into breast milk to a significant extent. They are also poorly absorbed. Warfarin is also considered to be compatible with breastfeeding as transfer is low, and adverse effects and changes in prothrombin time have not been detected in breastfed infants. However, it would be prudent to monitor the infant's prothrombin time during treatment.

http://www.medsafe.govt.nz/Profs/PUarticles/lactation.htm

QUOTE

Drug factors

(1)Diffusion or active transport -Drugs enter milk primarily by diffusion,i.e.as the mother ?s plasma drug level rises,the concentration in milk rises.This also means that most drugs will exit the milk as the maternal plasma concentration falls.

2 In a few instances drugs are transferred into milk by active transport mechanisms, resulting in greater concentrations of drug in milk than in maternal plasma. 6,9

(2)Protein binding -Drugs which are highly protein bound in the maternal plasma (e.g.warfarin)achieve lower breast milk levels. 1,2,11

http://www.ukmi.nhs.uk/NewMaterial/html/docs/19080202.pdf

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