Which two anticoagulants require special precautions during physical therapy due to increased bleeding risk?

Which two anticoagulants require special precautions during physical therapy due to increased bleeding risk?

• A. Warfarin and direct oral anticoagulants (DOACs)
• B. Heparin and Warfarin
• C. Aspirin and DOACs
• D. Enoxaparin and Aspirin

Answer: (A)

Managing bleeding risk is essential when a patient is on anticoagulants during physical therapy. Warfarin and direct oral anticoagulants (DOACs) are two major classes that impair the body’s ability to stop bleeding. Warfarin works by reducing the production of vitamin K–dependent clotting factors and is monitored with the INR. If the INR is elevated, even light trauma or gentle tissue work can lead to unexpected bleeding, so the therapy plan should be coordinated with the prescriber, and techniques should be chosen with caution, avoiding aggressive maneuvers when coagulation is not within a safe range. DOACs directly inhibit specific clotting factors and have more predictable effects, so routine lab monitoring isn’t required, but they still raise bleeding risk. In PT, timing sessions around dosing and watching for signs of bleeding—such as unusual bruising, prolonged bleeding, or hematomas—are important, and clinicians should coordinate with the prescribing clinician for safety. The combination of these two types of anticoagulants is commonly associated with bleeding risk in outpatient physical therapy, which is why special precautions are emphasized. Other pairings include a non-anticoagulant or are more typical of inpatient use, so they don’t fit the same outpatient precaution context as strongly.