Contraindications to Thromboprophylaxis
Mechanical thromboprophylaxis | 1. Bilateral amputee |
2. Bilateral lower extremity trauma or medical issue | |
3. Peripheral arterial insufficiency | |
Pharmacologic thromboprophylaxis | 1. Anesthesia/analgesia (neuraxial), single dose within past 24 ha |
2. Anesthesia/analgesia (neuraxial), within past 6 hb | |
3. Anticoagulated | |
4. Aspirin or other irreversible platelet inhibitor within past 7 d | |
5. AVM, aneurysm, CNS mass, Moyamoya | |
6. Bleeding (active, major) requiring transfusion, bleeding into vital organ, hemodynamic instability | |
7. Bleeding disorder/tendency or history of unexplained or spontaneous hemorrhage | |
8. Blood pressure (increased): SBP or DBP greater than 95th percentile for age, height, gender | |
9. Catheter placement (indwelling) epidural/spinala | |
10. Catheter removal epidural/spinal within past 2 ha,b | |
11. Coagulopathy: INR >1.5, aPTT ≥44 s, platelet count <50 000/mm3, or fibrinogen <100 g/dL | |
12. Comfort measures only | |
13. HIT history | |
14. Hepatic disease without known INR | |
15. Neurosurgery, head trauma within 3 d | |
16. Spinal hematoma or spinal stabilization surgery within past 24 h |
aPTT activated partial thromboplastin time; AVM, arteriovenous malformation; CNS, central nervous system; DBP, diastolic blood pressure; HIT, heparin-induced thrombocytopenia; INR, international normalized ratio; SBP, systolic blood pressure.
↵a For twice-daily enoxaparin dosing.
↵b For once-daily enoxaparin dosing.