p.66 抽出テキスト

• rabbits: increased number of fused and/or additional sternebrae (at the highest tested dose)

Vorapaxar Antiplatelet drug - Unknown Yes (excretion shown in rat milk)

Inadequate human data Animal data: • rats/rabbits: no defects in embryofoetal development (rats: 56 RHD; rabbits 26 RHD) • transient effects on sensory function and neurobehavioural development in pups at 67 RHD • decreased memory in female pups at 31 RHD • pre- and post-natal studies: rat pups had decreased survival and body weight gain (at 67 RHD)

Warfarin Vitamin K antagonist D Yes Yes (maximum of 10%), well tolerated as inactive metabolite

Coumarin embryopathy, bleeding (see discussion in sections 3 and 5 for use during pregnancy) For older substances, the former FDA classification is given wherever available; for newer substances released after 30 June 2015, the FDA classification has been replaced with detailed information from www.ema.europa.eu/, www.access data.fda.gov, http://www.embryotox.de, or from prescription labels provided by manufacturers. ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; AUC = area under the curve; FDA = US Food and Drug Administration; 5-HT1A = 5-hydroxytryptamine (serotonin); i.v. = intravenous; KLH = keyhole limpet haemocyanin; MRHD = maximum recommended human dose; RAAS = renin–angiotensin–aldosterone system; RHD = recommended human dose; UFH = unfractionated heparin; VTE = venous thrombo-embolism. aThe available data on first trimester use do not strongly support teratogenic potential.435,436 Because ACE inhibitors, ARBs, aldosterone antagonists, and renin inhibitors should be avoided during pregnancy and breastfeeding the risk cate- gory is D. Positive outcomes with ACE inhibitors have been described and pregnancy does not have to be terminated if the patient was exposed to these medications, but should be followed-up closely. bBreastfeeding is possible if the mother is treated with the drug.437 cAdenosine: Most experiences with this drug are in the second and third trimesters. Its short half-life may prevent it from reaching the foetus. dAtenolol is classified D by the FDA,438 although some authors classify it as C.439 eDigoxin: The experience with digoxin is extensive, and it is considered to be the safest antiarrhythmic drug during pregnancy. A prophylactic antiarrhythmic efficacy has never been demonstrated. fStatins: These should not be prescribed in pregnancy and during breastfeeding since their harmlessness is not proven. There are no expected disadvantages to the mother from a temporary interruption of the therapy during pregnancy. Downloaded from academic.oup.com/eurheartj/article/39/34/3165/5078465 by guest on 07 October 2026