Table 2.
Cardiac medications and safety profile in pregnancy.
| Drugs in pregnancy and lactation30: | |||
|---|---|---|---|
| Drug | Pregnancy (human vs animal studies) | Lactation (human vs animal studies) | Recommendations |
| Thrombolytics | |||
| Alteplase (10 case reports) | High molecular weight precludes transfer to the embryo | It is unknown if the drug crosses into placental milk. | Compatible with pregnancy and lactation |
| Reteplase (one case report) | Given the nature of the indication of use and short half-life it is unlikely that drug use during lactation will pose a significant problem. Reteplase is unlikely to cross into breast milk. | ||
| Urokinase (six case reports) |
Unsure if it crosses into the placenta. Proteinase inhibitors in placental tissue can inactivate urokinase |
Given the nature of the indication of use and short half-life it is unlikely that drug use during lactation will pose a significant problem | Low risk in pregnancy and probably compatible in lactation |
| Tenecteplase (no human data available) | |||
| Antiplatelet medications | |||
| Prasugrel | There is no human data available | No human data | There is no human data, animal data suggests low risk. Can be used in pregnancy if the benefits outweigh risks. Probably compatible with lactation. |
| Ticagrelor | There is no human data but animal data suggests risk to the fetus | No human data available | Animal data suggests risk, there is no human data available. If indicated in the mother the risks have to evaluated on a case-by-case basis Breastfeeding may be associated with potential toxicity |
| Clopidogrel | There is limited human data available, it is not teratogenic in animals. | No human data is available in breastfeeding. | There is limited human data, it is probably compatible with pregnancy, it is probably compatible with lactation. |
| Aspirin | With full dose aspirin human data suggests risk in the 1st and 3rd trimesters. Can be associated with IUGR, hemorrhage, teratogenic effects. Can prolong labor, premature closure of the ductus can occur in the premature infant. |
Limited human data available. Potential for salicylate toxicity | Low-dose aspirin is compatible with pregnancy. Limited human data suggests potential toxicity in the breast feeding infant. |
| Anticoagulants | |||
| Heparin | Does not cross the placenta | Not excreted into breast milk | Compatible with pregnancy and lactation |
| Bivalirudin | No human data, animal data suggests low risk | No human data | Can be used in pregnancy if the benefits outweigh risks. Probably compatible with lactation |
| Fondaparinux | Limited human data | No human data | Can be used if indicated in pregnancy. Probably compatible with lactation |
| Enoxaparin | Safe in pregnancy | No human data | Compatible with pregnancy and lactation |
| Glycoprotein receptor blockers | |||
| Abciximab | Does not reach the fetus in clinically significant amounts | Unlikely to be excreted in breast milk | Compatible with pregnancy and lactation |
| Eptifibatide, Tirofiban | Limited human data, animal data suggests low risk or is reassuring | The drug will likely be digested by the baby when ingested or no data available | Limited human data – animal data suggest low risk or compatible with pregnancy. Preferable to hold breastfeeding |