Anticoagulant therapy in patients with atrial fibrillation: management of bleeding

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Bleeding is the most common complication of long-term anticoagulant therapy. For patients with atrial fibrillation, it is important to consider the balance of hemorrhagic and thromboembolic risks in the event of bleeding since unreasonable withdrawal of anticoagulants can worsen the prognosis. The management of patients with hemorrhagic complications is determined according to the severity of bleeding, type of anticoagulant taken, and presence of high thromboembolic risk factors. The paper presents the author’s protocol for the management of patients with atrial fibrillation and various types of hemorrhagic complications against the background of anticoagulant therapy.

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About the authors

Irina V. Zotova

Center for Individualized Prevention and Treatment of Arterial and Venous Thrombosis, City Clinical Hospital Nо 17; Central State Medical Academy of department of presidential affairs of Russian Federation

Author for correspondence.
ORCID iD: 0000-0001-8309-8231

MD, Cand. Sci. (Med.)

Russian Federation, 21 Marshala Timoshenko st., 121359, Moscow; Moscow


  1. [internet]. Atrial fibrillation and flutter. Clinical guidelines, year of approval 2020. "Approved at the meeting of the Scientific and Practical Council of the Ministry of Health of the Russian Federation (meeting of 16.10.2020 Protocol No. 38/2–3–4)" [cited 2021 Feb 7]. Available from: (In Russ.)
  2. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio–Thoracic Surgery (EACTS). Eur Heart J. 2020. doi: 10.1093/eurheartj/ehaa612
  3. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104–132. doi: 10.1016/j.jacc.2019.01.011
  4. Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123(23):2736–2747.doi: 10.1161/CIRCULATIONAHA.110.009449
  5. Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70(24):3042–3067. doi: 10.1016/j.jacc.2017.09.1085
  6. Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015;373(25):2413–2424. doi: 10.1056/NEJMoa1510991
  7. Connolly SJ, Milling TJ, Jr., Eikelboom JW, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. N Engl J Med. 2016;375(12):1131–1141. doi: 10.1056/NEJMoa1607887.
  8. Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non–vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;39(16):1330–1393. doi: 10.1093/eurheartj/ehy136
  9. Revishvili AS, Shlyakhto EV, Zamyatin MN, et al. Peculiar features of urgent and emergency medical care of patients taking direct oral anticoagulants: consensus statement of multidisciplinary expert group. Journal of Аrrhythmology. 2018;(92):59–72. (In Russ.)

Supplementary files

Supplementary Files
1. Fig. General principles for the management of bleeding in patients receiving oral anticoagulants. VKA, vitamin K antagonists; AC, anticoagulants; DOAC, direct oral anticoagulants; FFP, fresh frozen plasma; INR, international normalized ratio; PRC, packed red cells.

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