Is coagulopathy a contraindication for thromboprophylaxis?

Abstract

In recent years, there is a heightened awareness of the risks of thrombosis in hospital patients. Considerable efforts in ensuring thromboprophylaxis for these inpatients have translated to significant reduction in thrombosis-related events in hospitals. In this regard, the National Institute of Clinical Excellence (NICE) has produced documents which guide physicians to prepare local protocols and implement these measures strictly.1 However, one of the caveats of these protocols, and indeed the NICE guidance, is the statement—‘thromboprophylaxis should be avoided in patients with an acquired bleeding disorder or coagulopathy’. Is this entirely true? In this context, it is important to examine the term ‘coagulopathy’. Most physicians consider clinical situations like liver disease and sepsis with or without disseminated intravascular coagulation as common causes of acquired bleeding disorder or coagulopathy. There is also a common habit among junior physicians of calling patients who have abnormal coagulation screen to include prothrombin time (PT) and activated partial thromboplastin time (APTT) as having coagulopathy. Although the term ‘coagulopathy’ literally means pathology of the coagulation system, it is important to bear in mind that it does not always imply a bleeding tendency, but can also mean an increased clotting or thrombotic risk, which also is a pathology of the coagulation system. Indeed, both liver disease and disseminated intravascular coagulation are conditions with increased thromboembolic risk. Also, …