- Active bleeding/high risk of bleeding- eGFR <30 mL/min/1.73 m2 (<1 year of age)- Cr >97.5th %ile- Liver dysfunction with coagulopathy or ALT > 5× ULN or total bilirubin >2× ULN with direct >20%- Use with dual P-glycoprotein/CYP3A4 inhibitors, e.g., azole-antimycotics or HIV protease inhibitors- Use with CYP3A4 inducers (e.g., rifampicin, phenytoin)- Those of childbearing potential without proper contraception, pregnancy or breastfeeding. The gene discussed is CYP3A4; the disease is Decreased liver function.