Can dabigatran be used in pregnant women?

Using dabigatran anticoagulation treatment for pregnant women could potentially affect fetal blood coagulation, according to a study published in Obstetrics & Gynecology. Dabigatran may cross the placenta to the fetus.

University of Toronto, Ontario, Canada, researchers conducted perfusion experiments by using 6 placentas from healthy term pregnancies after cesarean delivery.

As reported by Drug Topics, a sister publication to Contemporary OB/GYN, the researchers found evidence of the transfer of dabigatran and its prodrug dabigatran etexilate mesylate across the term human placenta from the mother to the fetus. These data suggest that, pending further study, dabigatran should not be used for anticoagulation of pregnant women, because the drug may have an adverse effect on fetal blood coagulation, the authors wrote.

“Researchers continue to gather more information regarding these new anticoagulants,” said James M. Wooten, PharmD, associate professor, department of medicine, section of clinical pharmacology, University of Missouri-Kansas City. 

“This information is very important since anticoagulation is sometimes necessary in pregnant women,” Dr. Wooten said. “Because warfarin is contraindicated in pregnancy, it was hoped that one of the new oral anticoagulants like dabigatran might be an alternative. This study demonstrates that dabigatran should also not be used in pregnancy.”

Dabigatran is a direct thrombin inhibitor, and it is unknown whether the other newer oral anticoagulants, which work by inhibiting factor Xa, will be contraindicated as well, according to Dr. Wooten. “Further study is necessary,” he said.

Bapat P Kedar R, Lubetsky A, et al. Transfer of dabigatran and dabigatran etexilate mesylate across the dually perfused human placenta. Obstet Gynecol. 2014;123(6):1256–1261.