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 |
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