Why the study?
Major bleeding is a feared adverse event during oral anticoagulation for AF, while clinical risk scores have modest predictive ability and specific patient factors need consideration to improve safety in the NOAC era.
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This review highlights practical considerations and risk factors for bleeding in patients with atrial fibrillation on oral anticoagulation, emphasizing specific vulnerable populations.
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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Undas et al. (2020) studied this question.
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