Is Warfarin Safe in Breastfeeding

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

Coumarin-type anticoagulant drug for the treatment and prophylaxis of thromboembolic disorders. Warfarin is not detected in breast milk. Not problems have been observed in infants whose mothers were treated. Plasma levels of warfarin in such infants were undetectable. Even in cases of accidental maternal overdosing, infants did not show any clinical problem and/or coagulation tests were not altered. American Academy of Pediatrics states that it is a medication usually compatible with breastfeeding.WHO List of Essential Medicines 2002: compatible with breastfeeding.

Because of the very low milk levels with warfarin doses up to at least 12 mg daily, amounts ingested by the infant are small. No adverse reactions in breastfed infants have been reported from maternal warfarin use during lactation, even with a dose of 25 mg daily for 7 days. There is a consensus that maternal warfarin therapy during breastfeeding poses little risk to the breastfed infant.[1][2][3][4][5] No special precautions are necessary.

No decreases in vitamin K-dependent clotting factors or bleeding occurred in 2 infants who were breastfed for 56 and 131 days, respectively, during maternal anticoagulation with warfarin.[6] In one telephone follow-up study, mothers taking warfarin reported no adverse effects among 5 breastfed infants.[8] A mother had been taking warfarin 5 mg daily for the first 7 weeks postpartum for a pulmonary embolism. At this time, she began taking 25 mg daily by mistake and took this dose for 7 days. Upon presentation to the emergency room, her INR was greater than 10 (usual therapeutic maximum 3.5), her prothrombin time was greater than 100 seconds (normal up to 11.2 seconds), and her aPTT was 62.5 seconds (normal up to 32.7 seconds). She had been nearly exclusively breastfeeding her infant since birth. Her 8-week-old infant was healthy with an INR of 1.0, prothrombin time of 10.3 seconds, and a slightly elevated aPTT 33.8 seconds. However, 3 weeks previously, the infant's aPTT was 38.9 seconds, so the elevated aPTT was judged not to be caused by warfarin.[9]