Pharmacologic thromboprophylaxis is usually contraindicated in the following patients

Patients with:

  • Active bleeding or intracranial hemorrhage,
  • A surgical procedure is planned in the immediate 6 to 12 hours (eg, spinal neuroaxial anesthesia),
  • A moderate or severe coagulopathy,
  • A severe bleeding diathesis or thrombocytopenia (eg, platelet count <50,000/microL or < 100,000/microL plus additional risk factors for bleeding).

Independent Risk Factors for Bleeding in Hospitalized Medical Patients

  • Active gastroduodenal ulcer
  • Bleeding in 3 mo before admission
  • Platelet count < 50 × 109/L
  • Age ≥85 y (vs < 40 y) Hepatic failure (INR > 1.5)
  • Severe renal failure (GFR < 30 mL/min/m2)
  • ICU or CCU admission
  • Central venous catheter
  • Rheumatic disease
  • Current cancer
  • Male sex

** Epistaxis and menstrual bleeding are not contraindications to pharmacologic thromboprophylaxis.

 

References

Chest. 2012 Feb;141(2 Suppl). https://www.ncbi.nlm.nih.gov/pubmed/22315261

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