Why the study?
Severe bleeding on oral anticoagulants carries substantial short-term mortality, creating a need for a multidisciplinary protocol to identify high-risk patients, optimize supportive care, treat the bleeding source, and judiciously administer reversal or hemostatic therapies.
Provides a multidisciplinary point-of-care algorithm for managing acute severe bleeding in patients on oral anticoagulants.
May inform point-of-care management of severe OAC bleeding; leaves open prospective trials of multidisciplinary protocols.
Bleeding complications associated with oral anticoagulant (OAC) frequently lead to emergency department visits and hospitalization. Short-term all-cause mortality after severe bleeding is substantial ranging from approximately 10% for gastrointestinal bleeding (the most frequent single site) to approximately 50% for intracranial bleeding. A protocol for multidisciplinary approach to bleeding is needed to (i) ensure rapid identification of patients at risk of adverse outcomes, (ii) optimize delivery of supportive measures, (iii) treat the source of bleeding, and (iv) administer anticoagulant reversal or hemostatic therapies judiciously for patients most likely to benefit. We convened a multidisciplinary panel of experts (emergency medicine, gastroenterology, general internal medicine, hematology, neurology, pharmacy, thrombosis) to review the literature and provide practical guidance including a corresponding algorithm for use at the point of care to assist clinicians in the management of patients with acute severe OAC-related bleeding.
No takes yet. Share an insight, caveat, or question.
Mithoowani et al. (2024) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: