Direct oral anticoagulants (DOACs)
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Direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, edoxaban and dabigatran, are rarely used in pregnancy but may occasionally be recommended by a specialist.
What are they?
DOACs are medicines to prevent and treat blood clots. They are used in people who are at risk of having a stroke or venous thromboembolism.
Individual DOACs include apixaban (Eliquis®), rivaroxaban (Xarelto®), edoxaban (Lixiana®), and dabigatran (Pradaxa®).
Benefits
What are the benefits of using a DOAC in pregnancy?
If you are at increased risk of a stroke or developing a blood clot in a vein (venous thromboembolism), taking a DOAC can help reduce your risk. However, DOACs are rarely used in pregnancy as there is not enough information to confirm they are safe for the baby.
Risks
What are the risks of using a DOAC in pregnancy?
There is a small amount of information on the use of rivaroxaban in pregnancy. The available evidence does not suggest that it causes birth defects or other pregnancy problems, but more research is needed to be certain.
There is very little information on use of the other DOACs in pregnancy, so it is not known if there are risks.
Taking a DOAC at the end of pregnancy may increase your chance of heavy bleeding during childbirth (postpartum haemorrhage). Because DOACs can cross the placenta, there is a possibility that your baby may also be more likely to experience bleeding complications. If you have used a DOAC in late pregnancy, your doctor will recommend that your baby is delivered in hospital so that you can both be closely monitored and treated if needed.
Alternatives
Are there any alternatives to taking a DOAC in pregnancy?
Yes, usually. Most women who take a DOAC can be switched to a different anticoagulant called low-molecular-weight heparin (LMWH), which is considered safe for pregnancy. If possible, this change is usually made before you get pregnant. If you are taking a DOAC and planning a pregnancy, you should arrange an appointment with your doctor or specialist so they can review your medication. Do not stop or make changes to your medicines unless advised by your doctor.
A DOAC will only be recommended in pregnancy if there is no suitable alternative and the benefits of treating a potentially serious condition outweigh the possible risks of using the medication.
No treatment
What if I prefer not to take medicines in pregnancy?
It is important to continue taking medicines to prevent blood clots, as these can be serious. Your doctor will only prescribe medicines when necessary and will be happy to discuss any concerns so that you can make an informed decision.
Will I or my baby need extra monitoring?
As part of your routine antenatal care, you will be offered a detailed ultrasound scan at around 20 weeks of pregnancy to check your baby’s development.
If you have a health condition that affects your heart or circulation, you may be offered extra monitoring during pregnancy to make sure that you remain well and that your baby is growing as expected.
Are there any risks to my baby if the father has taken a DOAC?
We do not expect any increased risk to your baby if the father takes a DOAC.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.