Excretion of Rivaroxaban in Human Breast Milk

The aim of our study is to perform a phase 1, single arm clinical trial to investigate the distribution of rivaroxaban into human milk at both therapeutic and prophylactic maternal doses. Our goal is to enhance the limited, although positive, data regarding the safety of rivaroxaban in breastfeeding. Our novel contributions to the existing body of literature will be in our investigation of rivaroxaban at both prophylactic and therapeutic doses, in repeated doses over time, and in a larger sample of participants. These results will provide physicians and national societies with safety data needed to properly counsel patients and advance clinical guidelines for postpartum care.

Inclusion criteria

• Postpartum within 6 weeks of delivery
• Greater than 18 years old at expected date of delivery
• English speaking
• Hemodynamically stable without concern for ongoing blood loss
• Non-breastfeeding
• Or breastfeeding an infant born at or equal to 37 weeks' gestation, weighing >2600g at birth and is not requiring intensive care
• Meet inclusion criteria for prophylactic rivaroxaban dose: pre-pregnancy BMI >/= 40 and/or any personal history of VTE. Or >/= 2 of the following: pre-pregnancy BMI 30-39, immobility, pregnancy complications, cesarean delivery, hysterectomy
• Or meet inclusion criteria for therapeutic rivaroxaban dose: have an indication for therapeutic anticoagulation per the American College of Obstetricians and Gynecologists' (ACOG) practice bulletin #196, or other indication per their primary team, and recommended for such anticoagulation per their primary practitioner.

Exclusion criteria

• Pregnant
• Less than 18 years old at estimated date of delivery
• Hemodynamic instability and/or concern for ongoing blood loss
• Newly diagnosed deep vein thrombosis (DVT) or pulmonary embolism (PE) in the postpartum period
• Abnormal maternal renal or liver function (creatinine clearance < 30 mL/min and/or liver function tests greater than lab normal)
• A contraindication to rivaroxaban: hypersensitivity to rivaroxaban; active pathological bleeding
• Breastfeeding an infant admitted to neonatal intensive care unit, infant gestational age at birth <37w0d or weighing <2600g.
• If all of the following are met: age less than 40, ambulating, body mass index (BMI) less than 30, no active history of malignancy.
• If patient lacks indication for therapeutic anticoagulation in the postpartum period per the American College of Obstetricians and Gynecologists' (ACOG) practice bulletin #196