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Pulmonary Thromboembolism - PE - Risk of Bleeding

Risk Factors for Bleeding

Age >65 yearsDiabetes
Previous bleedingAnaemia
CancerAntiplatelet therapy

Alcohol abuse

  • ≥8 drinks per week

Poor anticoagulant control

  • Time in therapeutic range

Liver failure

  • Cirrhosis
  • Bilirubin > 2x normal
  • AST/ALT/AP >3x normal

Renal failure

  • Dialysis
  • Transplant
  • Cr >200╬╝mol/L
Previous bleedingRecent surgery
CancerFrequent falls
ThrombocytopeniaCo-morbidity or reduced capacity
Previous strokeNSAID use

Categorisation of Risk of Bleeding

  • Low risk (1.6%) - 0 risk factors
  • Intermediate risk (3.2%) - 1 risk factor
  • High risk (12.8%) - ≥2 risk factors

Contraindications to the use of Thrombolytic Therapy

ABSOLUTE CONTRAINDICATIONSRELATIVE CONTRAINDICATIONS
Structural intracranial cerebrovascular diseaseSystolic blood pressure>180
Previous intracranial haemorrhageDiastolic bleed pressure >110
Ischemic stroke within 3 monthsRecent bleeding (non-intracranial)
Active bleedingRecent surgery major surgery (within 3 weeks)
Recent brain or spinal surgeryRecent invasive procedure (e.g. indwelling urinary catheters, intramuscular injections, chest drain, paracentesis - within the past 10 days)
Recent head trauma with fracture or brain injuryIschaemic stroke more than 3 months previously
Bleeding diathesis (e.g. thrombocytopenia)Anticoagulated (e.g. VKA therapy)
Known malignant intracranial neoplasmTraumatic cardiopulmonary resuscitation
 Severe renal or hepatic dysfunction
 Pericarditis or pericardial fluid
 Diabetic retinopathy
 Pregnancy
 Dementia
 Age >75 years

Contraindications to the use of Anticoagulation

HAS-BLED score (developed to evaluate bleeding risk for anticoagulation in Afib) can also identify patients with acute VTE at high risk for bleeding complications within 6 months

ABSOLUTE CONTRAINDICATIONSRELATIVE CONTRAINDICATIONS
Structural intracranial cerebrovascular diseaseSystolic blood pressure >180
Acute intracranial haemorrhageDiastolic bleed pressure >110
Active bleedingSevere renal or hepatic dysfunction
Bleeding diathesis (e.g. thrombocytopenia)Diabetic retinopathy
Known malignant intracranial neoplasmRecent brain or spinal surgery
Active ulcerative, angiodysplastic or variceal gastrointestinal diseaseAge >75 years
Known hypersensitivity or adverse reaction to anticoagulantRecent ophthalmic surgery
Previous HITTS (heparin)Previous intracranial haemorrhage

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