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Oral Blood Thinners in Pregnancy

"Is there an oral blood thinner I can use instead of shots during pregnancy?"

"I went to the hospital for pain in my leg last week and they found a a blood clot in my leg. They sent me home on lovenox injections. I have a big fear of needles, and was wondering if there is an oral blood thinner I can use? "

Low molecular weight heparins , Lovenox (enoxaparin) , Fragmin (dalteparin) , and Innohep (tinzaparin) are the treatment of choice for blood clots during pregnancy. Low molecular weight heparins are effective and safe for treatment or prophylaxis of venous thromboembolism during pregnancy, because they do not cross the placenta. Unfortunately these drugs come only in the injectable form [4].

Warfarin (Coumadin®) is the most common oral anticoagulant used to prevent blood clots. Warfarin use during pregnancy causes defects in the offspring of exposed mothers including include nasal hypoplasia, stippled epiphyses, limb deformities, mental retardation, and seizures [1]. It is used rarely during pregnancy such as  in the treatment of women with artificial heart valves where there may be no safer effective medicine available [3].

There is no significant data supporting the safety of newer oral anticoagulants ( eg, rivaroxaban , apixaban, and dabigatran) during human pregnancy [5-7].   Because most of these drugs are small molecules they would be expected to cross the placenta and might have harmful effects on the fetus. Authorities have recommended these drugs should be avoided in pregnancy at present [2,3]


1. Hall JG , et al. Maternal and fetal sequelae of anticoagulation during pregnancy.Am J Med. 1980 ;68:122-40.  PMID: 6985765
2. Greer IA.Thrombosis in pregnancy: updates in diagnosis and management.
Hematology Am Soc Hematol Educ Program. 2012;2012:203-7. doi: 10.1182/asheducation-2012.1.203.PMID: 23233582
3. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, and Vandvik PO (2012) VTE, thrombophilia, antithrombotic therapy, and pregnancy. Chest 141(2 Suppl):e691S–e736S.
4.  Inherited thrombophilias in pregnancy. Practice Bulletin No. 124 American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:730-40.
5. XARELTO (rivaroxaban) tablet, film coated package insert.
6. ELIQUIS (apixaban) tablet, film coated package insert
7. PRADAXA (dabigatran etexilate mesylate) capsule package insert

Reviewed by Mark Curran, M.D., FACOG


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