Contraindications to warfarin therapy
Contraindications to warfarin are any localised or general physical condition or personal circumstance in which the hazard of haemorrhage might be greater than the potential clinical benefit of anticoagulation. These include:
haemorrhagic tendencies and blood dyscrasias
recent or contemplated surgery of the central nervous system or the eye
traumatic surgery resulting in large open surfaces.
Warfarin is contraindicated if the patient is unwilling or unable to comply with monitoring due to cognitive impairment, alcoholism, psychosis or problems with accessing services.
In the major interventional trials studying the efficacy of warfarin for stroke reduction in atrial fibrillation, patients considered at excessive risk of bleeding were excluded (Table 1).These exclusion criteria resulted in the recruitment of a fit group with only a very small sub-group of very elderly people, so there are inherent problems in extrapolating the study results into everyday practice.