Pulmonary Thromboembolism - PE - Risk of Bleeding
Risk Factors for Bleeding
| Age >65 years | Diabetes |
| Previous bleeding | Anaemia |
| Cancer | Antiplatelet therapy |
Alcohol abuse
| Poor anticoagulant control
|
Liver failure
| Renal failure
|
| Previous bleeding | Recent surgery |
| Cancer | Frequent falls |
| Thrombocytopenia | Co-morbidity or reduced capacity |
| Previous stroke | NSAID 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 CONTRAINDICATIONS | RELATIVE CONTRAINDICATIONS |
|---|---|
| Structural intracranial cerebrovascular disease | Systolic blood pressure>180 |
| Previous intracranial haemorrhage | Diastolic bleed pressure >110 |
| Ischemic stroke within 3 months | Recent bleeding (non-intracranial) |
| Active bleeding | Recent surgery major surgery (within 3 weeks) |
| Recent brain or spinal surgery | Recent invasive procedure (e.g. indwelling urinary catheters, intramuscular injections, chest drain, paracentesis - within the past 10 days) |
| Recent head trauma with fracture or brain injury | Ischaemic stroke more than 3 months previously |
| Bleeding diathesis (e.g. thrombocytopenia) | Anticoagulated (e.g. VKA therapy) |
| Known malignant intracranial neoplasm | Traumatic 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 CONTRAINDICATIONS | RELATIVE CONTRAINDICATIONS |
|---|---|
| Structural intracranial cerebrovascular disease | Systolic blood pressure >180 |
| Acute intracranial haemorrhage | Diastolic bleed pressure >110 |
| Active bleeding | Severe renal or hepatic dysfunction |
| Bleeding diathesis (e.g. thrombocytopenia) | Diabetic retinopathy |
| Known malignant intracranial neoplasm | Recent brain or spinal surgery |
| Active ulcerative, angiodysplastic or variceal gastrointestinal disease | Age >75 years |
| Known hypersensitivity or adverse reaction to anticoagulant | Recent ophthalmic surgery |
| Previous HITTS (heparin) | Previous intracranial haemorrhage |