phenprocoumon and Puerperal-Disorders

As the passage of phenprocoumon into human milk has not been studied yet, mothers on oral anticoagulation with Phenprocoumon are advised to stop breastfeeding in order to avoid the potential hazards of vitamin K deficiency haemorrhage in their babies. We analysed the passage of Phenprocoumon into human milk in a breastfeeding mother of a premature baby (gestational age 32 weeks), who required oral anticoagulation on day 19 post partum. The mother was advised to continue collecting her milk with an electric pump, and to resume breastfeeding, if a significant passage of the drug was excluded. Milk Sampling (fore and hind milk pairs (n = 2), for milk (n = 4), 24 h pooled collections) for the Phenprocoumon analyses with an HPLC method was performed on days 27, 28, and 31 when the Quick's Prothrombin time was stable in the therapeutic range (Phenprocoumon plasma concentrations: 1.8-2.2 micrograms/ml).. Phenprocoumon was higher in hind than in foremilk. With constant plasma concentrations the variability between different foremilk samples was 26-76 ng/ml. The Phenprocoumon concentration in the 24 h pooled sample was 33 ng/ml. Estimates of the Phenprocoumon secretion into human breast milk should be from pooled milk samples of a 24 h collection. Phenprocoumon in human milk is only about 1/50 of the corresponding maternal plasma concentrations. The estimated daily Phenprocoumon intake from maternal milk in a baby drinking about 200 ml/kg/day is 6-8 micrograms/kg. This is much less the average maintenance requirement for anticoagulation with Phenprocoumon in children (about 50 micrograms/kg/day).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Breast Feeding; Chromatography, High Pressure Liquid; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Milk, Human; Phenprocoumon; Puerperal Disorders; Pulmonary Embolism

Reported in this paper is a favourable side-effect of heparin-falithrome prophylaxis used to minimise the risk of thromboembolism to women in puerperium with pronounced varicosis or with a record of thromboembolism. Incidence of impaired involution of the uterus in puerperium, lochial congestion, endometritis, and, consequently, genitally caused fever in patients exposed to heparin action was found to be lower with significance than it had been among puerperal patients without such prophylaxis. The possible mechanism underlying that favourable side-effect, not reported elsewhere in the past, is discussed in greater detail in this paper.

Topics: 4-Hydroxycoumarins; Anticoagulants; Drug Therapy, Combination; Endometritis; Female; Heparin; Humans; Phenprocoumon; Pregnancy; Puerperal Disorders; Thromboembolism; Uterus

Topics: Anticoagulants; Coumarins; Female; Humans; Phenprocoumon; Postpartum Period; Puerperal Disorders; Thromboembolism