Is Apixaban for atrial fibrillation safe during pregnancy?

Question

Hi doctor,

I am 40 and have atrial fibrillation, on Apixaban and beta blockers. I am thinking about trying for a baby, but I am not sure if blood thinners are allowed in pregnancy. Could AFib episodes cause any danger to the fetus? Do I need to switch off Apixaban before conception? I feel fine now, but I am worried about how my heart rhythm may change while pregnant.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

Thank you for reaching out with such an important and thoughtful question.

Planning pregnancy while living with atrial fibrillation (AFib) and being on medications like Apixaban does require careful consideration, but it is absolutely possible with the right support.

Apixaban (Eliquis) is a direct oral anticoagulant (DOAC), and unfortunately, it is not recommended during pregnancy due to limited safety data and potential risks to the fetus. If you are considering pregnancy, your cardiologist and gynecologist will likely recommend transitioning to a safer anticoagulant, such as low molecular weight heparin (for example, Enoxaparin), which has been used more safely in pregnancy.

Pregnancy causes significant cardiovascular changes, like increased blood volume, heart rate, and stress on the heart. These can trigger AFib episodes. While AFib itself is not typically dangerous to the fetus directly, uncontrolled heart rhythm or inadequate blood flow could impact both maternal and fetal health, especially if symptoms like palpitations, shortness of breath, or fainting occur.

Before trying to conceive, I strongly recommend a preconception consultation with:

Your cardiologist to adjust medications and assess your rhythm stability.
A maternal-fetal medicine (MFM) specialist to plan a high-risk but safe pregnancy.
Your primary gynecologist can coordinate care during the pregnancy.

Many women with AFib successfully carry healthy pregnancies, but it does require close monitoring of both their heart rhythm and anticoagulation status throughout.

Please do not hesitate to reach out for help coordinating this care or if you would like a personalized referral. You are taking the right steps by asking early, and with the right medical plan, pregnancy can be safe and fulfilling for you and your baby.

Hope this answers your query.

Thank you.