| Guideline | Resources |
| Active Bleeding on Oral Anticoagulants | 2023 ACC/AHA/ACCP/HRS, 2020 ESC/EACTS, 2020 ACC Guideline Synthesis |
Key Points
Major bleeding = critical site, hemodynamic instability, 2 g/dL hemoglobin ↓, 2 units RBC transfusion. Stop OAC; identify, control, and treat cause of bleeding. Failure to achieve hemostasis is assoc w/ high mortality risk. Use specific agents approved for specific OACs: idarucizumab for dabigatran-induced major bleeding; andexanet alfa for apixaban- or rivaroxaban-associated major bleeding. If unavailable, use PCC. For pts on warfarin, 4-factor PCC preferred over FFP.
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Peer reviewed & based on multiple guidelines/recommendations from specialty societies/government agencies.
Epocrates Guideline Synopsis Last Update:
Mar 26, 2024
Publication Year:
2023
Source:
epocrates
ACC/AHA/ACCP/HRS Levels of Evidence
| [A] | High-quality evidence from ≥1 RCT, or ≥1 RCT corroborated by high-quality registries |
| [B-R] | Mod-quality evidence from ≥1 RCT |
| [B-NR] | Mod-quality evidence from ≥1 well-designed, well-executed nonrandomized, observational, or registry study |
| [C-LD] | Observational/registry studies w/ limitations of design/execution; physiological/mechanistic studies |
| [C-EO] | Consensus of expert opinion based on clinical experience |
ESC Levels of Evidence
| [A] | Data from multiple RCTs/meta-analyses |
| [B] | Data from single RCT or large nonrandomized studies |
| [C] | Consensus of opinion and/or small/retrospective studies, registries |
Abbreviations
| 4F-PCC | 4-factor prothrombin complex concentrate |
| AF | atrial fibrillation |
| DOAC | direct oral anticoagulant |
| FFP | fresh frozen plasma |
| GI | gastrointestinal |
| HTN | hypertension |
| ICH | intracranial hemorrhage |
| INR | international normalized ratio |
| LAAO | left atrial appendage occlusion |
| MI | myocardial infarction |
| MRI | magnetic resonance imaging |
| NOAC | novel oral anticoagulant |
| OAC | oral anticoagulant |
| PCC | prothrombin complex concentrate |
| VTE | venous thromboembolism |
ACC/AHA/ACCP/HRS Levels of Evidence
| A | = | High-quality evidence from ≥1 RCT, or ≥1 RCT corroborated by high-quality registries |
| B-R | = | Mod-quality evidence from ≥1 RCT |
| B-NR | = | Mod-quality evidence from ≥1 well-designed, well-executed nonrandomized, observational, or registry study |
| C-LD | = | Observational/registry studies w/ limitations of design/execution; physiological/mechanistic studies |
| C-EO | = | Consensus of expert opinion based on clinical experience |
ESC Levels of Evidence
| A | = | Data from multiple RCTs/meta-analyses |
| B | = | Data from single RCT or large nonrandomized studies |
| C | = | Consensus of opinion and/or small/retrospective studies, registries |