Which drug is contraindicated in a patient with a known gastrointestinal bleed?

Enoxaparin, a low molecular weight heparin, is contraindicated in patients with a known gastrointestinal bleed due to its anticoagulant properties. This medication is used to prevent and treat thromboembolic disorders by inhibiting factor Xa, which leads to decreased blood clotting. In patients with active bleeding, particularly from the gastrointestinal tract, the use of enoxaparin could exacerbate the bleeding risk, leading to potentially life-threatening complications.

While warfarin, aspirin, and clopidogrel also have anticoagulant or antiplatelet effects and can be risky in the context of a gastrointestinal bleed, enoxaparin's risk is particularly pronounced due to its injection route and the potential for rapid accumulation and significant anticoagulation effect. Therefore, managing a patient with a known GI bleed would require avoidance of enoxaparin to mitigate the risk of worsening the condition.