Reducing bleeding risk in patients on oral anticoagulation therapy

ABSTRACT

Introduction

Oral anticoagulation (OAC) significantly mitigates thromboembolism risks in atrial fibrillation (AF) and venous thromboembolism (VTE) patients yet concern about major bleeding events persist. In fact, clinically relevant hemorrhages can be life-threatening. Bleeding risk is dynamic and influenced by factors such as age, new comorbidities, and drug therapies, and should not be assessed solely based on static baseline factors.

Areas covered

We comprehensively review the bleeding risk associated with OAC therapy. Emphasizing the importance of assessing both thromboembolic and bleeding risks, we present clinical tools for estimating stroke and systemic embolism (SSE) and bleeding risk in AF and VTE patients. We also address overlapping risk factors and the dynamic nature of bleeding risk.

Expert opinion

The OAC management is undergoing constant transformation, motivated by the primary objective of mitigating thromboembolism and bleeding hazards, thereby amplifying patient safety throughout the course of treatment. The future of OAC embraces personalized approaches and innovative therapies, driven by advanced pathophysiological insights and technological progress. This holds promise for improving patient outcomes and revolutionizing anticoagulation practices.

KEYWORDS:

• ABC pathway
• atrial fibrillation
• bleeding risk
• clinical risk estimation tools
• oral anticoagulation
• non-vitamin K antagonist oral anticoagulants
• thromboembolic risk
• vitamin K antagonists

Article highlights

• OAC therapy effectively prevents thromboembolic events but carries a risk of significant bleeding. However, the clinical benefits outweigh the bleeding risk.

• Clinical risk estimation tools help determine individual SEE risk in patients with AF and VTE. Identifying and addressing modifiable bleeding risk factors can reduce the risk of bleeding.

• Bleeding risk factors overlap with thromboembolic risk factors and are influenced by age, comorbidities, and medications.

• The Atrial fibrillation Better Care (ABC) pathway offers a comprehensive approach to AF management.

• Reducing bleeding risk in OAC treatment is a significant challenge requiring preventive strategies and innovative therapeutic approaches.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.