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Anticoagulation - oral - Management
Who should not receive warfarin, or receive a reduced dose?

Contraindications or cautions for the use of warfarin include:

  • Haemorrhagic stroke.
  • Bleeding disorders, such as:
    • Uncorrected major bleeding — avoid using warfarin until the bleeding has stopped and the cause healed.
    • Uncorrected major bleeding disorder — for example, thrombocytopenia, haemophilia, liver failure, renal failure.
    • Potential bleeding lesions — for example; active peptic ulcer; oesophageal varices; aneurysm; proliferative retinopathy; recent organ biopsy; recent trauma or surgery to head, orbit, or spine; recent stroke; confirmed intracranial or intraspinal bleed; or within 72 hours of major surgery with risk of severe bleeding, or within 48 hours postpartum.
  • Uncontrolled severe hypertension — for example, systolic blood pressure greater than 200 mmHg or diastolic pressure greater than 120 mmHg.
  • Pregnancy — due to the risk of teratogenicity with warfarin.
  • The person is uncooperative or unreliable — as there may be compliance and follow-up issues.
  • The person is prone to repeated falls or unstable gait — since there is an increased chance of injury and head trauma.
  • Concomitant use of antiplatelet drugs, nonsteroidal anti-inflammatory drugs, selective serotonin-reuptake inhibitors (SSRIs), venlafaxine, or duloxetine — there is an increased risk of gastrointestinal bleeding (see Drug interactions).
  • Protein C deficiency — a risk of skin necrosis on initiation of warfarin requires caution.

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