Warfarin Contraindications

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Warfarin is one of the most widely used drugs in the world for a variety of indications involving the prevention and treatment of thromboembolic phenomena. Even after 60 years of its use, warfarin's narrow threshold of toxicity, combined with its dose-response ratio and the many factors that determine how well it works in humans, supports its continued evaluation by researchers around the world.

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One primary consideration in the use of warfarin is whether there are any contraindications to its use. These may be absolute, forbidding its use under any circumstances whatsoever, or relative, in which case the physician needs to balance the risks of bleeding complications against the risks of thromboembolism posed by the disease condition requiring warfarin therapy.

Absolute contraindications

Some of the absolute contraindications to warfarin include:

  • Large esophageal varices
  • Patients who have undergone major surgery within the last 72 hours
  • A platelet count less than 50 x 109/cu.mm, which constitutes significant thrombocytopenia
  • Hypersensitivity to the drug, such as skin ischemic necrosis or priapism
  • A clinically significant bleeding condition; however, the patient's risks of warfarin can be reassessed after three months
  • Pregnancy and within 48 hours of delivery because of warfarin's known teratogenicity, as well as its capacity to induce spontaneous abortion and fetal/perinatal bleeding
  • Coagulation defects at baseline such that the international normalized ratio (INR) is over 1.5
  • Decompensated liver disease

Relative contraindications

Relative contraindications require a careful balancing of the risks of warfarin against the risks of thromboembolism before making a decision to administer the drug. These relative contraindications include:

  • Previous history of intracranial hemorrhage
  • Recent history of a major extracranial bleed without known cause
  • History of peptic ulceration within the past three months. In these cases, it is recommended that the patient waits to begin warfarin therapy until treatment of peptic ulcer is completed.
  • Recent history of repeated falling episodes with a patient at a higher risk for bleeds
  • Likelihood of poor patient compliance due to dementia or cognitive impairment, particularly in cases when there is no available caretaker.
  • Alcoholism, especially binge drinking
  • Poorly controlled or untreated hypertension


Further Reading

Last Updated: Feb 13, 2023

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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  1. Gabriel Reyes Posada Gabriel Reyes Posada Colombia says:

    Can I take Mebemint together with warfarine?

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