Is Enoxaparin Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Enoxaparin? Is Enoxaparin safe for nursing mother and child? Does Enoxaparin extracts into breast milk? Does Enoxaparin has any long term or short term side effects on infants? Can Enoxaparin influence milk supply or can Enoxaparin decrease milk supply in lactating mothers?

This is a Heparin with low molecular weight There is published evidence of a lack of anti-coagulant activity in the serum of breastfed infants whose mothers were treated with Enoxaparin. The high molecular weight of the so-called standard or non-fragmented Heparin and others called low weight Heparins makes that excretion into breast milk very unlikely. There is scientific proof on the lack of excretion of Dalteparin into breast milk. In addition, Heparin derived drugs are inactivated in the gut and they are not absorbed at all, hence, oral bioavailability is nil. The risk of Heparin-induced Thrombocytopenia and Osteoporosis is lower with low weight Heparin among treated adults.

Limited information indicates that maternal enoxaparin in doses up to 40 mg daily do not to cause any adverse effects in breastfed infants. Because its large molecular weight of 2000 to 8000 daltons, enoxaparin would not be expected to be excreted into breastmilk or to be absorbed from breastmilk by the infant. No special precautions are required.[1]

Ten women received enoxaparin 20 mg and 2 received 40 mg daily by subcutaneous injection from the prepartum to the postpartum period. At 5 to 7 days postpartum, anti-Xa activity (a measurement of enoxaparin anticoagulant activity) was undetectable in their 12 completely breastfed term neonates 1.5 to 3 hours after they were breastfed for at least 5 days. No bleeding was detected among the infants during maternal enoxaparin therapy.[2] A pregnant woman suffered blood clots in the sinuses and 2 small intracranial hemorrhages at 8 weeks of gestation, followed by status epilepticus. She was treated with enoxaparin 40 mg twice daily throughout pregnancy and for 3 months postpartum as well as levetiracetam and lacosamide. Her infant was about 50% breastfed for the first 15 days of life. The infant showed normal development at 7 months of age.[3]