I am a registered nurse on the postpartum floor. Recently I had a patient who was on heparin IV and would soon be taking coumadin at home. The question came up about whether she could breastfeed while on the anticoagulants. I called the pharmacy to make sure and was told that heparin is safe to breastfeed with due to its high molecular weight resulting in safe breastfeeding. I was told on the other hand that it would only be safe in low doses when she eventually started taking coumadin. I informed the patient and the next day she wanted to confirm it with the doctor. He disagreed. This posed quite a dilemma and I didn't know what to tell her. I hated to send her home so confused about something as important to her as breastfeeding her new baby. I am concerned that I will be faced with this dilemma again. Can you help?
Heparin is an anticoagulant that is administered by IV or injection. It is used to help decrease the blood's clotting ability and to help prevent clots from forming in the blood vessels. It has a very high molecular weight. Because of this, it is unlikely that any would be secreted into breastmilk. If a small amount did enter a mother's milk it would be rapidly destroyed in the infant's stomach. It is considered to be compatible with breastfeeding. (Hale 2000)
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.
It is still wise to use caution when providing patient education about this or any medication. The patients' physicians need to evaluate any special circumstances that may relate to the individual, but even if the infant is at a higher risk, as with prematurity, the warfarin can be easily countered with small doses of vitamin K to the infant. Mothers receiving anticoagulant therapy should be taught to observe the infant for bleeding, unusual bruising or reddish spots (petechia) and report those conditions to their physicians at once. (Hale 2000).
Best wishes in your work with new moms!
Reference:
- Hale, T. Medications and Mother's Milk, Pharmasoft Publishers, Texas, 158-59, 2000
