Certain conditions may increase the risk of bleeding following anticoagulation. Clinicians must decide between the hazards of therapy and the potential benefits for the patient.


Absolute contraindications:

(1) subarachnoid or intracerebral hemorrhage

(2) serious active bleeding (post-operative, post-traumatic, etc.)

(3) recent surgery or trauma to brain, eye or spinal cord

(4) malignant hypertension


Relative contraindications:

(1) recent major surgery

(2) recent stroke

(3) active gastrointestinal bleeding

(4) severe hypertension

(5) coagulopathy

(6) bacterial endocarditis

(7) severe renal failure

(8) severe hepatic failure


In trauma patients, the following injuries may warrant withholding anticoagulation for a week or more after injury:

(1) intracranial hemorrhage or contusion

(2) incomplete spinal cord injury with hematoma or contusion

(3) nonoperative liver, spleen or kidney injury

(4) ocular injury within 2 weeks

(5) pelvic fracture with hemorrhage (large hematoma, > 2 units of blood transfused in 24 hours, embolization, urgent external fixation)


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