- Major surgery, serious trauma, lumbar puncture, arterial puncture at a noncompressible site, or biopsy of a parenchymal organ in last 14 days. Major surgical procedures include but are not limited to the following: major thoracic or abdominopelvic surgery, neurosurgery, major limb surgery, carotid endarterectomy or other vascular surgery, and organ transplant. For unlisted procedures, the operating surgeon should be consulted to assess the risk