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CC BY 4.0 · Thromb Haemost 2025; 125(08): 717-732
DOI: 10.1055/a-2464-2887
Review Article

Multidisciplinary Expert Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians

Siraj Mithoowani
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Tammy Bungard
2   Department of Medicine, University of Alberta, Edmonton, Canada
,
Lana Castellucci
3   Department of Medicine, University of Ottawa, Ottawa, Canada
4   Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Canada
,
Mark Crowther
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Kerstin de Wit
5   Department of Emergency Medicine, Queen's University, Kingston, Canada
,
Dar Dowlatshahi
3   Department of Medicine, University of Ottawa, Ottawa, Canada
4   Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Canada
,
Nauzer Forbes
6   Department of Medicine, University of Calgary, Calgary, Canada
,
Katie Lin
6   Department of Medicine, University of Calgary, Calgary, Canada
,
Deborah M. Siegal
3   Department of Medicine, University of Ottawa, Ottawa, Canada
4   Inflammation and Chronic Disease Program, Ottawa Hospital Research Institute, Ottawa, Canada
› Author Affiliations
Funding Thrombosis Canada received an unrestricted educational grant from AstraZeneca to develop this algorithm. The funding source had no role in the design, content, writing, editing, or decision to submit this manuscript for publication.
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Abstract

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.

Keywords

anticoagulation - bleeding - anticoagulant reversal - warfarin - DOAC - treatment


Publication History

Received: 25 July 2024

Accepted: 05 November 2024

Accepted Manuscript online:
08 November 2024

Article published online:
13 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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