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Possible contraindications to anticoagulation

Possible contraindications to anticoagulation
Possible contraindication Factors to consider
Active, clinically significant bleeding Site and degree of bleeding (eg, nosebleeds and menses generally are not a contraindication; active intracerebral bleeding is almost always an absolute contraindication), interval since bleeding stopped
Severe bleeding diathesis Nature, severity, and reversibility of bleeding diathesis
Severe thrombocytopenia (platelet count <50,000/microL) Absolute platelet count, platelet count trend, and platelet function (eg, some individuals with ITP and a platelet count in the range of 30,000 to 50,000 may tolerate anticoagulation if needed)
Major trauma  Site and extent of trauma, time interval since event (eg, for a patient with a mechanical heart valve it may be appropriate to anticoagulate sooner after trauma than a patient with a lesser indication)
Invasive procedure or obstetric delivery (recent, emergency, or planned)  Type of procedure and associated bleeding risk, interval between procedure and anticoagulation
Previous intracranial hemorrhage Time interval since hemorrhage and underlying cause (eg, trauma or uncontrolled hypertension)
Intracranial or spinal tumor  Site and type of tumor, other comorbidities
Neuraxial anesthesia  Interval since spinal/epidural puncture or catheter removal, other alternatives for anesthesia; traumatic procedures are more concerning
Severe, uncontrolled hypertension  Absolute blood pressure and blood pressure trend
This list does not take the place of clinical judgment in deciding whether or not to administer an anticoagulant. In any patient, the risk of bleeding from an anticoagulant must be weighed against the risk of thrombosis and its consequences. The greater the thromboembolic risk, the greater the tolerance for the possibility of bleeding and for shortening the time interval between an episode of bleeding and anticoagulant initiation. Refer to UpToDate content on the specific indication for the anticoagulant and the specific possible contraindication for discussions of these risks.
ITP: immune thrombocytopenia.
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