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