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Clark, Steven L. MD; Porter, T. Flint MD; West, Frederick G. PhD

Clinical Commentary

Coumarin derivatives are the anticoagulants most widely used in the United States. These agents are relatively contraindicated during pregnancy, and the use of these drugs in breast-feeding women remains controversial. Much of the confusion regarding the passage of these agents into breast milk might stem from the fact that different agents possess significantly different chemical properties. A review of the chemical structure of different coumarin derivatives, as well as available clinical evidence, suggests that warfarin sodium is not excreted into breast milk, and can be safely given to women requiring therapeutic anticoagulation postpartum. For the rare patient who cannot tolerate warfarin sodium, the use of dicumarol, rather than anisindione, is preferred.

Warfarin sodium can be appropriately prescribed for breast-feeding mothers requiring anticoagulation.

Intermountain Health Care, the Department of Chemistry, and the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.

Address reprint requests to: Steven L. Clark, MD, Division of Perinatology, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143. E-mail:

Received September 8, 1999. Received in revised form November 2, 1999. Accepted December 1, 1999.

© 2000 The American College of Obstetricians and Gynecologists