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The benefit of anticoagulation for prevention of stroke in patients with atrial fibrillation has been well established. However, the benefit is always to be weighed against the risk, in this case, primarily bleeding. Among the many potential reasons not to anticoagulate, other factors that predispose to bleeding are often brought up. My question is about one such condition — thrombocytopenia (low platelets).

In a patient with atrial fibrillation who otherwise meets criteria for anticoagulation,1 what level of thrombocytopenia2 is considered a relative contraindication to anticoagulation?


1. Of course, not all "meets criteria" are the same. For the sake of the question, let't discuss the sort of "middle risk" group (nonvalvular afib, CHA2DS2-VASc = 2-3). Let us also assume no prior bleeding history.

2. Using whatever units you would like, but as far as I know normal people talk about count per mm3 = mL, with a normal range 150k-400k.

3

There are a number of indices used to assess bleeding risk

Bleeding risk scores to quantify hemorrhage risk include HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly), RIETE (Computerized Registry of Patients With Venous Thromboembolism), HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Rebleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) (206-208).

but at present ( 2014 )

Although these scores may be helpful in defining patients at elevated bleeding risk, their clinical utility is insufficient for use as evidence for the recommendations in this guideline. [2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676081/

However, there are some guidelines for oncology patients though they are old (2007)

Oncology guideliness

American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer.

So, your only recourse is to seek local expert opinion in non-oncology patients.

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