Careful assessment of bleeding episodes needed with oral anticoagulants
A new expert consensus decision pathway from the American College of Cardiology recommends that assessment and treatment of a bleeding episode in patients on oral anticoagulants is essential for the optimal care of these patients.
The document is a valuable summary of the most recent and evidence-based information to assist healthcare professionals in managing patients experiencing bleeding on oral anticoagulation. It also provides standardised definitions of major bleeding, when you should reverse anticoagulation and when you should consider restarting anticoagulation.
The pathway, published in the Journal of the American College of Cardiology, is described as a pragmatic, clinically useful algorithm that would allow clinicians to:
- Assess bleeding
- Provide recommendations to manage the bleeding
- Give guidance on reinitiating anticoagulant therapy in patients who have had bleeding problems
In particular, the document provides useful recommendations on the management of the direct oral anticoagulants dabigatran, rivaroxaban, edoxaban and apixaban, including how to assess the current state of anticoagulation with these agents and some of the options for therapeutic interventions to mitigate or reverse their anticoagulant effect. Although there is still a knowledge gap on how to reverse apixaban and rivaroxaban, the authors provide a framework in which to approach patients with major bleeding who are being treated with these therapies.
2017 ACC Expert Consensus Decision Pathway on management of bleeding in patients on oral anticoagulation.