🔹Absolute Contraindications of anticoagulants
*Active bleeding
*Severe bleeding diathesis
*Recent, planned, or emergency high bleeding-risk surgery/procedure
*Major trauma
*Acute intracranial hemorrhage
▫️Relative Contraindications of anticoagulants
*Recurrent bleeding from multiple gastrointestinal telangiectasias
*Intracranial or spinal tumors
*Large abdominal aortic aneurysm with concurrent severe hypertension
*Stable aortic dissection
*Recent, planned, or emergent low bleeding-risk surgery/procedure
▫️Some considerations:
*Thrombocytopenia is not always a contraindication to anticoagulation (eg, those with counts >50,000/microL)
*Patients with a history of intracranial hemorrhage (eg, due to aneurysm successfully ablated) may be candidates for anticoagulation, but the decision should be individualized.
*Special consideration should also be given to avoiding anticoagulation, when feasible, in older patients (eg, >65 years) with a history of multiple falls and the presence of more than one factor that elevates
the bleeding risk.
*Patients with a recent episode of epistaxis or heavy menstrual bleeding are not generally considered high risk for bleeding and anticoagulation can usually be administered safely in this population.
🔹Absolute contraindications for fibrinolytic therapy
*Prior intracranial hemorrhage
*Known structural cerebral vascular lesion
*Known malignant intracranial neoplasm
*Ischemic stroke within 3 months (excluding stroke within 3 hours), The American College of Cardiology suggests that select patients with stroke may benefit from thrombolytic therapy within 4.5 hours of the onset of symptoms.
*Suspected aortic dissection
*Active bleeding(GI, ICH, etc) or bleeding diathesis (excluding menses or epistaxis)
*Significant closed-head trauma or facial trauma within 3 months
▫️Relative contraindications for fibrinolytic
*History of chronic, severe, poorly controlled hypertension
*Severe uncontrolled hypertension on presentation (SBP >180 mmHg or DBP >110 mmHg)
*History of ischemic stroke >3 months prior
*Traumatic or prolonged (>10 minutes) CPR or major surgery <3 weeks
*Recent (within 2 to 4 weeks) internal bleeding
*Noncompressible vascular punctures
*Recent invasive procedure
*Pregnancy
*Active peptic ulcer
*Pericarditis or pericardial fluid
*Current use of anticoagulant (eg, warfarin sodium) that has produced an elevated INR >1.7 or PT >15 seconds
*Age >75 years
*Diabetic retinopathy
*For streptokinase/anistreplase – Prior exposure (>5 days ago) or prior allergic reaction to these agents
🔹Absolute Contraindications of antiplatelet therapy
*Active Major Bleeding: E.g., GI, intracranial, or retroperitoneal.
*Prior Intracranial Hemorrhage (ICH): Especially spontaneous ICH.
*Severe Hypersensitivity: E.g., anaphylaxis to aspirin or P2Y12 inhibitors.
*Severe Thrombocytopenia: Platelets <50,000/µL.
▫️Relative Contraindications of antiplatelet therapy
*Recent Surgery/Trauma: Major surgery within 2-4 weeks (longer for neurosurgery).
*Recent Minor Bleeding: E.g., GI bleed within 1-3 months, active peptic ulcer.
*High Bleeding Risk with Anticoagulation: Triple therapy increases risk.
*Severe Liver Disease: Coagulopathy with INR >1.5 or low platelets.
*Severe Renal Impairment: CrCl <30 mL/min (caution, not absolute).
*Prior Stroke/TIA: Contraindicated for prasugrel; caution with others.
*Pregnancy (High Dose): Aspirin >100 mg/day near term.
*Neuraxial Procedures: P2Y12 inhibitors stopped 5-7 days prior.
*High Fall Risk: Elderly/frail patients with bleeding propensity.
▫️Drug-Specific:
*Aspirin: Avoid in AERD or severe GI intolerance.
*Prasugrel: No use in prior stroke/TIA or age >75 (unless high ischemic need).
*Ticagrelor: Caution in bradycardia or severe dyspnea risk.
*Vorapaxar: Avoid with ICH/stroke/TIA history