Contraindications to Thromboprophylaxis

Mechanical thromboprophylaxis1. Bilateral amputee
2. Bilateral lower extremity trauma or medical issue
3. Peripheral arterial insufficiency
Pharmacologic thromboprophylaxis1. 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.