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Low-molecular-weight heparin.
Indicated in the treatment and prevention of arterial, venous or pulmonary thromboembolism and in acute coronary syndrome.
Authorized use in neonates and infants.
Subcutaneous administration.
Absence of anticoagulant activity in plasma of infants breastfed by mothers treated with enoxaparin has been reported (Guillonneau 1996).
No problems have been observed in infants of mothers treated with enoxaparin (Ylikotila 2015, Guillonneau 1996).
The high molecular weight of standard or unfractionated heparin and also of the so-called low molecular weight heparins makes it very unlikely that they will pass into breast milk in a clinically significant amount.
There is virtually no excretion in breast milk of another low molecular weight heparin, dalteparin (Richter 2001).
In addition, heparins are inactivated in the gastrointestinal tract, not being absorbed (practically zero oral bioavailability), which prevents the passage into plasma of the infant from ingested breast milk (Sanofi 2020, AEMPS 2020).
The risk of heparin-induced thrombocytopenia and osteoporosis is lower with low molecular weight heparins (Fuller 2013, Middeldorp 2011, Rath 2010).
The manufacturer, various medical societies, experts and expert consensus consider the use of this medication safe during breastfeeding (Hale, Lactmed, Sanofi 2020, AEMPS 2020, Bates 2018 and 1997, Noviani 2016, Briggs 2015, Schaefer 2015, Fuller 2013, Yurdakök 2012, Rath 2010).