TY - JOUR
T1 - Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism
T2 - Executive Summary of a European and Asia-Pacific Expert Consensus Paper
AU - Gorog, Diana A.
AU - Gue, Ying X.
AU - Chao, Tze Fan
AU - Fauchier, Laurent
AU - Ferreiro, Jose Luis
AU - Huber, Kurt
AU - Konstantinidis, Stavros V.
AU - Lane, Deirdre A.
AU - Marin, Francisco
AU - Oldgren, Jonas
AU - Potpara, Tatjana
AU - Roldan, Vanessa
AU - Rubboli, Andrea
AU - Sibbing, Dirk
AU - Tse, Hung Fat
AU - Vilahur, Gemma
AU - Lip, Gregory Y.H.
N1 - Thieme. All rights reserved.
PY - 2022/10
Y1 - 2022/10
N2 - While there is a clear clinical benefit of oral anticoagulation in patients with atrial fibrillation (AF) and venous thromboembolism (VTE) in reducing the risks of thromboembolism, major bleeding events (especially intracranial bleeds) may still occur and be devastating. The decision for initiating and continuing anticoagulation is often based on a careful assessment of both thromboembolism and bleeding risk. The more common and validated bleeding risk factors have been used to formulate bleeding risk stratification scores, but thromboembolism and bleeding risk factors often overlap. Also, many factors that increase bleeding risk are transient and modifiable, such as variable international normalized ratio values, surgical procedures, vascular procedures, or drug-drug and food-drug interactions. Bleeding risk is also not a static one-off assessment based on baseline factors but is dynamic, being influenced by aging, incident comorbidities, and drug therapies. In this executive summary of a European and Asia-Pacific Expert Consensus Paper, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in patients with AF and VTE, with a view to summarizing best practice when approaching antithrombotic therapy in these patients. We address the epidemiology and size of the problem of bleeding risk in AF and VTE, and review established bleeding risk factors and summarize definitions of bleeding. Patient values and preferences, balancing the risk of bleeding against thromboembolism, are reviewed, and the prognostic implications of bleeding are discussed. We propose consensus statements that may help to define evidence gaps and assist in everyday clinical practice.
AB - While there is a clear clinical benefit of oral anticoagulation in patients with atrial fibrillation (AF) and venous thromboembolism (VTE) in reducing the risks of thromboembolism, major bleeding events (especially intracranial bleeds) may still occur and be devastating. The decision for initiating and continuing anticoagulation is often based on a careful assessment of both thromboembolism and bleeding risk. The more common and validated bleeding risk factors have been used to formulate bleeding risk stratification scores, but thromboembolism and bleeding risk factors often overlap. Also, many factors that increase bleeding risk are transient and modifiable, such as variable international normalized ratio values, surgical procedures, vascular procedures, or drug-drug and food-drug interactions. Bleeding risk is also not a static one-off assessment based on baseline factors but is dynamic, being influenced by aging, incident comorbidities, and drug therapies. In this executive summary of a European and Asia-Pacific Expert Consensus Paper, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in patients with AF and VTE, with a view to summarizing best practice when approaching antithrombotic therapy in these patients. We address the epidemiology and size of the problem of bleeding risk in AF and VTE, and review established bleeding risk factors and summarize definitions of bleeding. Patient values and preferences, balancing the risk of bleeding against thromboembolism, are reviewed, and the prognostic implications of bleeding are discussed. We propose consensus statements that may help to define evidence gaps and assist in everyday clinical practice.
KW - atrial fibrillation
KW - bleeding
KW - oral anticoagulation
KW - risk assessment
KW - venous thromboembolism
KW - Risk Assessment
KW - Humans
KW - Risk Factors
KW - Fibrinolytic Agents/therapeutic use
KW - Anticoagulants/adverse effects
KW - Venous Thromboembolism/diagnosis
KW - Hemorrhage/epidemiology
KW - Stroke/epidemiology
KW - Atrial Fibrillation/complications
UR - http://www.scopus.com/inward/record.url?scp=85134775538&partnerID=8YFLogxK
U2 - 10.1055/s-0042-1750385
DO - 10.1055/s-0042-1750385
M3 - Review article
C2 - 35793691
AN - SCOPUS:85134775538
SN - 0340-6245
VL - 122
SP - 1625
EP - 1652
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 10
ER -