Contraindications to Anticoagulation

Absolute Contraindications

Active major bleeding requiring more than 2 units of blood transfusions in 24 hours is an absolute contraindication to anticoagulation, as recommended by the National Comprehensive Cancer Network 1, 2
Recent intracranial hemorrhage or central nervous system bleeding is an absolute contraindication to anticoagulation, according to the American College of Radiology 1, 2
Intracranial or spinal lesions at high risk for bleeding are an absolute contraindication to anticoagulation, as stated by the National Comprehensive Cancer Network 1, 2, 3
Recent spinal anesthesia or lumbar puncture is an absolute contraindication to anticoagulation due to the risk of spinal or epidural hematoma, as recommended by the National Comprehensive Cancer Network 1, 3, 4
Severe thrombocytopenia with a platelet count less than 50,000/mcL is an absolute contraindication to anticoagulation, according to the National Comprehensive Cancer Network and the American College of Radiology 1, 2

Chronic clinically significant bleeding lasting more than 48 hours is a relative contraindication to anticoagulation, as recommended by the National Comprehensive Cancer Network 1, 5
Recurrent but inactive gastrointestinal bleeding is a relative contraindication to anticoagulation, according to the American College of Radiology 2, 6
Recent major surgery with intermediate bleeding risk is a relative contraindication to anticoagulation, as stated by the American College of Radiology 2, 6
High risk for falls and/or head trauma is a relative contraindication to anticoagulation, as recommended by the National Comprehensive Cancer Network and the American College of Radiology 1, 2, 3
Moderate thrombocytopenia with a platelet count between 50,000-150,000/mcL is a relative contraindication to anticoagulation, according to the National Comprehensive Cancer Network and the American College of Radiology 1, 2
Severe platelet dysfunction from uremia, medications, or dysplastic hematopoiesis is a relative contraindication to anticoagulation, as stated by the National Comprehensive Cancer Network 1, 5

Prolonged aPTT in patients with lupus anticoagulant or antiphospholipid syndrome is not a contraindication to anticoagulation, as recommended by the National Comprehensive Cancer Network 1, 5
Peptic ulcer disease without active bleeding is not an absolute contraindication to anticoagulation, according to the American College of Radiology 2, 6
History of guaiac-positive stools alone is not an absolute contraindication to anticoagulation, as stated by the American College of Radiology 2, 6
Trauma and neurosurgical patients can generally be anticoagulated after the first or second postoperative week, as recommended by the American College of Radiology 2, 6
Stroke patients without intracranial hemorrhage can typically be anticoagulated, according to the American College of Radiology 2, 6
Spinal cord injuries without hematomyelia may be considered for anticoagulation, as stated by the American College of Radiology 2, 6
Frequent reevaluation of contraindications and risk-benefit assessment is essential, particularly in cancer patients at increased bleeding risk, to facilitate implementation of anticoagulation when it becomes clinically prudent, as recommended by the National Comprehensive Cancer Network 1, 7, 3