For lactating women using warfarin, acenocoumarol, or UFH who wish to breast-feed, we suggest continuing the use of warfarin, Woman with AF on NOAC Woman with AF on VKA If planned pregnancy or diagnosis of pregnancy VKA until end of 5th week (LMWH as an alternative) VKA replaced by LMWH from 6th to 12th week LMWH replaced by VKA until 36th week (maintenance of LMWH as an alternative) VKA replaced by LMWH from 36th week to 24 h before delivery or cesarean section VKA or LMWH during lactation Figure 8 Management of women with AF during pregnancy is shown. LMWH low-molecular-weight heparin. See Figure 1 and 3 legends for expansion of other abbreviations. 1182 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] acenocoumarol, LMWH or UFH (Ungraded consensus-based statement). 49. For breast-feeding women, we suggest alternative anticoagulants rather than NOACs (Ungraded consensus-based statement). AF and CKD CKD is frequently present in patients with AF and has signi cant implications on the trajectory of AF, risk of stroke, and bleeding risk of anticoagulation. The presence of CKD or AF bi-directionally affects the incident risk of the other. Among patients with CKD, the prevalence of AF is substantially higher than in the general population, ranging from 16% to 21% in nondialysis dependent CKD and 15% to 40% in patients Among patients with AF, CKD is present in one-third of patients at the time of AF diagnosis51,429 although this may be substantially higher among cohorts of prevalent AF subjects. 