6
Table 1. Contraindications to Therapeutic Anticoagulant in
Patients with Cancer
a
Absolute Contraindications
b
Non-DOAC Anticoagulants and DOAC Anticoagulants:
• Active major, serious or potentially life-threatening bleeding not reversible with
medical or surgical intervention, including but not limited to any active bleeding in a
critical site (e.g., intracranial, pericardial, retroperitoneal, intraocular, intra-articular,
intra-spinal)
• Severe, uncontrolled malignant hypertension
• Severe, uncompensated coagulopathy (e.g., liver failure)
• Severe platelet dysfunction or inherited bleeding disorder
• Persistent, severe thrombocytopenia (<20,000/µL)
• High risk invasive procedure in a critical site, including but not limited to lumbar
puncture, spinal anesthesia, epidural catheter placement
DOAC-specific:
• Concurrent use of potent P-glycoprotein or CYP3A4 inhibitors or inducers
Relative Contraindications
c
Non-DOAC Anticoagulants and DOAC Anticoagulants:
• Intracranial or spinal lesion at high risk for bleeding
d,e
• Active GI ulceration at high risk of bleeding
d,e
• Active but non-life-threatening bleeding (e.g. trace hematuria)
d,e
• Intracranial or CNS bleeding within past 4 weeks
d,e
• Recent high-risk surgery or bleeding event
d,e
• Persistent thrombocytopenia (<50,000/µL)
d,e
Patients for Whom Anticoagulation Is of Uncertain Benefit
• Patient receiving end of life/hospice care
• Very limited life expectancy with no palliative or symptom reduction benefit
• Asymptomatic thrombosis with concomitant high risk of serious bleeding
Patient Characteristics and Values
• Preference or refusal
• Non-adherence to dosing schedule, follow-up or monitoring
Treatment
