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Stroke

Intro

THIS WEBSITE IS CURRENTLY UNDER CONSTRUCTION.

This information is not intended as a substitute for professional healthcare and is not intended to replace the evaluation of a healthcare professional. No responsibility is accepted for clinical decisions arising from use of this tool. Always consult with a healthcare provider for advice concerning your health. Only your healthcare provider can determine the medical recommendations for your neurological condition. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.

Pregnancy-related stroke is uncommon. Although studies have shown that pregnancy increases the risk of stroke among all women, especially during the postpartum period, the risk of stroke remains low. Most women with a history of stroke are able to have healthy pregnancies.

Importantly, after a stroke, medications may be started to reduce the risk of stroke recurrence. Given the increased risk of stroke during pregnancy and the postpartum period, some medications may be continued throughout pregnancy to protect against recurrency.

Blood thinners are often used to reduce the risk of another ischemic stroke. This is a large category with many medications. Two classes of blood-thinning medications commonly started after ischemic stroke include antiplatelets and anticoagulants. The decision about which class of medications to use depends on the cause of the stroke.

Antiplatelet medications include aspirin, clopidogrel, ticagrelor, prasugrel. Anticoagulant medications include warfarin, dabigatran, rivaroxaban, edoxaban, apixaban, and heparin.

If you require antiplatelet medications for stroke prevention during pregnancy, the only safe choice is low dose (81 mg) Aspirin. Unfortunately, there is not enough evidence available so far to support the use of other antiplatelet medications (clopidogrel, ticagrelor, prasugrel) during pregnancy.

If you require anticoagulation for stroke prevention during pregnancy, the safest choice is low molecular weight heparin (LMWH) as it does not cross the placenta. Warfarin has been found to be harmful with an increased risk of birth defects in the baby so it should be avoided, especially between 6 to 12 weeks of gestational age. There is not enough data on the safety of newer anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during pregnancy.

Many other medications are used following a stroke and they may cause fetal harm (e.g., cholesterol, blood pressure, and diabetes medications) but this tool focuses ONLY on the safety of blood thinners use for mother and baby. If you have questions about the other medications you are taking, please talk to your physician.

Medication Safety Checker

Add drug to check for safety

    • Ticagrelor (Brilinta)

      NA

      Condition-specific uses

      Ticagrelor condition-specific uses

      Uses

      The neurological reasons for use are:

      • Prevention and treatment of ischemic stroke.
      • Neck artery (carotid artery) stent placement to prevent ischemic stroke.

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Ticagrelor (Brilinta) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

    • Apixaban (Eliquis)

      NA

      Condition-specific uses

      Apixaban stroke-specific uses

      Uses

      The neurological reason for use is ischemic stroke treatment and prevention due to abnormal heart rhythm (atrial fibrillation).

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine apixaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Apixaban (Eliquis) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine apixaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Apixaban (Eliquis) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine apixaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Apixaban (Eliquis) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If apixaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

    • Fondaparinux

      NA

      Uses

      It is used in place of warfarin and other blood things during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      Fondaparinux is a low-molecular-weight heparin. Intravenous (IV) unfractionated heparin can be considered for a pregnant person in the hospital in place of low molecular weight heparin. Follow standardized hospital protocols, especially if there is a concern for urgent delivery or invasive procedures.

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Fondaparinux (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Fondaparinux is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Fondaparinux (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Fondaparinux is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Fondaparinux (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Fondaparinux is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    • Enoxaparin (low molecular weight heparin) (Lovenox, Redesca)

      NA

      Uses

      It is used in place of warfarin and other blood things during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      Intravenous (IV) unfractionated heparin can be considered for a pregnant person in the hospital in place of low molecular weight heparin. Follow standardized hospital protocols, especially if there is a concern for urgent delivery or invasive procedures.

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Enoxaparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Enoxaparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Enoxaparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Enoxaparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Enoxaparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Enoxaparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    • Clopidogrel (Plavix)

      NA

      Uses

      The neurological reasons for use are:

      • Prevention and treatment of ischemic stroke.
      • Neck artery (carotid artery) stent placement to prevent ischemic stroke.

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Clopidogrel (Plavix) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

    • Nadroparin

      NA

      Uses

      It is used in place of warfarin and other blood things during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      Nadroparin is a low-molecular-weight heparin. Intravenous (IV) unfractionated heparin can be considered for a pregnant person in the hospital in place of low molecular weight heparin. Follow standardized hospital protocols, especially if there is a concern for urgent delivery or invasive procedures.

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Nadroparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Nadroparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Nadroparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Nadroparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Nadroparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Nadroparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    • Warfarin (coumadin)

      • NA

      Uses

      Neurological reasons for use:

      Ischemic stroke treatment and prevention due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or new clot in heart, legs, or lung
      • Prior or new clot in brain veins

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      Warfarin is not safe at any dosage for the mother. It can cause spontaneous abortion, miscarriage, and still-birth.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Warfarin is not safe at any dosage for the baby. It can cause major birth defects including brain abnormality, risk of brain bleed in the baby, heart defects, and bone abnormalities.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      Warfarin is not safe at any dosage for the mother. It can cause spontaneous abortion, miscarriage, and still-birth.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Warfarin is not safe at any dosage for the baby. It can cause major birth defects including brain abnormality, risk of brain bleed in the baby, heart defects, and bone abnormalities.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      Warfarin is not safe at any dosage for the mother. It can cause miscarriage, still-birth, and bleeding during labour.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Warfarin is not safe at any dosage for the baby. It can cause major birth defects including brain abnormality, risk of brain bleed in the baby, heart defects, and bone abnormalities. It can also cause low birth-weight, developmental delay, and deafness in the newborn.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping warfarin.

      If warfarin is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

    • Prasugrel (Effient)

      NA

      Uses

      The neurological reasons for use are:

      • Prevention and treatment of ischemic stroke.
      • Neck artery (carotid artery) stent placement to prevent ischemic stroke.

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

      Unsafe use (fetus)

      There are not enough studies to determine the effects and safety of Prasugrel (Effient) for the fetus during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider an alternative option (aspirin) if this medication is required for certain indications as decisions are made on a case-by-case basis.

    • Dabigatran (Pradaxa)

      NA

      Uses

      The neurological reason for use is ischemic stroke treatment and prevention due to abnormal heart rhythm (atrial fibrillation).

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine dabigatran's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Dabigatran (Pradaxa) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine dabigatran's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Dabigatran (Pradaxa) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine dabigatran's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Dabigatran (Pradaxa) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If dabigatran is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

    • Dalteparin (Fragmin)

      NA

      Uses

      It is used in place of warfarin and other blood things during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      Dalteparin is a low-molecular-weight heparin. Intravenous (IV) unfractionated heparin can be considered for a pregnant person in the hospital in place of low molecular weight heparin. Follow standardized hospital protocols, especially if there is a concern for urgent delivery or invasive procedures.

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Dalteparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Dalteparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Dalteparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Dalteparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Dalteparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Dalteparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    • Acetylsalicylic acid (Aspirin)

      NA

      Uses

      Neurological reasons for use:

      • Ischemic stroke treatment and prevention
      • Neck vessel dissection (tear)
      • Lupus (autoimmune disease) related strokes

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Low dose aspirin (60-100 mg) daily is safe for the mother during pregnancy.

      This drug can safely be used in pregnancy at low doses.

      Safe use (fetus)

      Low dose aspirin (60-100 mg) daily is safe for the fetus.

      This drug can safely be used in pregnancy at low doses.

      Unsafe use (mother)

      Higher doses of aspirin (more than 100 mg, up to 150 mg) daily are not safe for the mother as it could be associated with pregnancy loss.

      This section is currently being updated. Check back later!

      Unsafe use (fetus)

      Higher doses of aspirin (more than 100 mg, up to 150 mg) daily are not safe for the fetus as it could be associated with birth defects.

      This section is currently being updated. Check back later!

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Both low (60-100 mg) and higher (more than 100 mg, up to 150 mg) doses of aspirin are safe for the mother.

      This drug can safely be used in pregnancy if doses are less than 150 mg.

      Safe use (fetus)

      Both low (60-100 mg) and higher (more than 100 mg, up to 150 mg) doses of aspirin are safe for the fetus.

      This drug can safely be used in pregnancy if doses are less than 150 mg.

      Unsafe use (mother)

      While 60-150 mg doses of aspirin are considered safe, the safety of doses higher than 150 mg is inconclusive.

      This section is currently being updated. Check back later!

      Unsafe use (fetus)

      While 60-150 mg doses of aspirin are considered safe, the safety of doses higher than 150 mg is inconclusive.

      This section is currently being updated. Check back later!

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Both low (60-100 mg) and higher (more than 100 mg, up to 150 mg) doses of aspirin are safe for the mother.

      This drug can safely be used in pregnancy if doses are less than 150 mg.

      Safe use (fetus)

      Both low (60-100 mg) and higher (more than 100 mg, up to 150 mg) doses of aspirin are safe for the fetus.

      This drug can safely be used in pregnancy if doses are less than 150 mg.

      Unsafe use (mother)

      While 60-150 mg doses of aspirin are considered safe, the safety of doses higher than 150 mg is inconclusive.

      This section is currently being updated. Check back later!

      Unsafe use (fetus)

      While 60-150 mg doses of aspirin are considered safe, the safety of doses higher than 150 mg is inconclusive.

      This section is currently being updated. Check back later!

    • Edoxaban (Lixiana)

      NA

      Uses

      The neurological reason for use is ischemic stroke treatment and prevention due to abnormal heart rhythm (atrial fibrillation).

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine edoxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Edoxaban (Lixiana) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine edoxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Edoxaban (Lixiana) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine edoxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Edoxaban (Lixiana) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If edoxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

    • Heparin (unfractionated)

      NA

      Uses

      It is used in place of warfarin and other blood things during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Heparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Heparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Heparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Heparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Heparin (at both preventive and intermediate doses) is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Heparin is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    • Rivaroxaban (Xarelto)

      NA

      Uses

      The neurological reason for use is ischemic stroke treatment and prevention due to abnormal heart rhythm (atrial fibrillation).

      First trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine ribaroxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Rivaroxaban (Xarelto) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Second trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine rivaroxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Rivaroxaban (Xarelto) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Third trimester

      SafetyConcernNext steps
      Unsafe use (mother)

      There are not enough studies to determine rivaroxaban's effects and safety for the mother during pregnancy.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

      Unsafe use (fetus)

      Rivaroxaban (Xarelto) is not safe at any dosage for the fetus because the medication can cross the placenta. Small studies have reported birth defects, low birth weight, and growth and developmental delays in newborns.

      Please talk to your primary provider (family physician or obstetrician) to consider alternative options before stopping.

      If rivaroxaban is required for certain reasons, then low molecular weight heparin can be considered as an alternate option and this decision must be made after discussion with your healthcare provider (family physician or obstetrician or cardiologist or neurologist).

    • Tinzaparin (Prinnohep, Innohep)

      Uses

      Tinzaparin is used in place of warfarin and other blood thinners during pregnancy to prevent or treat ischemic stroke due to:

      • Abnormal heart rhythm (atrial fibrillation)
      • Mechanical heart valves
      • Prior or existing clot in heart, legs, brain veins, or lung
      • Clots in neck vessels due to dissection (tear)
      • Antiphospholipid syndrome

      Tinzaparin is a low-molecular-weight heparin. Intravenous (IV) unfractionated heparin can be considered for a pregnant person in the hospital in place of low molecular weight heparin. Follow standardized hospital protocols, especially if there is a concern for urgent delivery or invasive procedures.

      First trimester

      SafetyConcernNext steps
      Safe use (mother)

      Tinzaparin (Prinnohep), at both preventive and intermediate doses, is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Tinzaparin (Prinnohep) is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Second trimester

      SafetyConcernNext steps
      Safe use (mother)

      Tinzaparin (Prinnohep), at both preventive and intermediate doses, is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Tinzaparin (Prinnohep) is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Third trimester

      SafetyConcernNext steps
      Safe use (mother)

      Tinzaparin (Prinnohep), at both preventive and intermediate doses, is safe for the mother during pregnancy. Studies have shown that bleeding risk during pregnancy is similar to women who are not pregnant.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

      Safe use (fetus)

      Tinzaparin (Prinnohep) is safe for the fetus during pregnancy because the medication does not cross the placenta.

      This drug can safely be used in pregnancy at both preventive and/or intermediate treatment doses.

    Disclaimer

    Some safety considerations/recommendations provided in this web-based tool are based on limited studies and current evidence. This web-based tool must not be used as the sole base of decision-making in the use of medicines during pregnancy.

    Expert health care provider consultation with a family doctor/neurologist/cardiologist/obstetrician is required throughout the process of change, as decisions should be based on an individual’s specific circumstances.

    Many other medications are used following a stroke and they may cause fetal harm (e.g., cholesterol, blood pressure, and diabetes medications) but this tool focuses ONLY on the safety of blood thinners use for mother and baby. If you have questions about the other medications you are taking, please talk to your physician.