open access

Vol 78, No 2 (2020)
Review paper
Published online: 2020-01-14
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Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

Anetta Undas, Leszek Drabik, Tatjana Potpara
DOI: 10.33963/KP.15205
·
Kardiol Pol 2020;78(2):105-116.

open access

Vol 78, No 2 (2020)
Review article
Published online: 2020-01-14

Abstract

Major bleeding (especially intracranial hemorrhage) is the most feared adverse event observed in patients with atrial fibrillation (AF) receiving oral anticoagulation. Clinical risk factor–based scores have modest ability to predict major or clinically relevant bleeds, and blood biomarkers are increasingly implemented to improve bleeding prognostication in patients with AF on life‑long anticoagulation. To improve the safety of anticoagulation in the era of non–vitamin K antagonist oral anticoagulants (NOACs, or direct oral anticoagulants [DOACs], including dabigatran, rivaroxaban, apixaban, and edoxaban), specific demographic, clinical, and laboratory variables should be considered. The current review summarizes practical challenges in the management of oral anticoagulation with emphasis on the risk assessment tools, elderly or underweight patients, cancer patients, impact of chronic kidney disease, liver cirrhosis, and thrombocytopenia in the context of bleeding risk in patients with AF.

Abstract

Major bleeding (especially intracranial hemorrhage) is the most feared adverse event observed in patients with atrial fibrillation (AF) receiving oral anticoagulation. Clinical risk factor–based scores have modest ability to predict major or clinically relevant bleeds, and blood biomarkers are increasingly implemented to improve bleeding prognostication in patients with AF on life‑long anticoagulation. To improve the safety of anticoagulation in the era of non–vitamin K antagonist oral anticoagulants (NOACs, or direct oral anticoagulants [DOACs], including dabigatran, rivaroxaban, apixaban, and edoxaban), specific demographic, clinical, and laboratory variables should be considered. The current review summarizes practical challenges in the management of oral anticoagulation with emphasis on the risk assessment tools, elderly or underweight patients, cancer patients, impact of chronic kidney disease, liver cirrhosis, and thrombocytopenia in the context of bleeding risk in patients with AF.

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About this article
Title

Bleeding in anticoagulated patients with atrial fibrillation: practical considerations

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 78, No 2 (2020)

Article type

Review paper

Pages

105-116

Published online

2020-01-14

Page views

533

Article views/downloads

397

DOI

10.33963/KP.15205

Bibliographic record

Kardiol Pol 2020;78(2):105-116.

Authors

Anetta Undas
Leszek Drabik
Tatjana Potpara

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