ACC releases decision pathway on bleeding in patients on oral anticoagulants

The pathway covers relevant laboratory tests, acute medical and surgical management, need for reversal, and the appropriateness and timing of restarting anticoagulation.


An expert consensus decision pathway on management of bleeding in patients on oral anticoagulants was released by the American College of Cardiology on Dec. 1.

The pathway addresses bleeding complications in patients taking direct oral anticoagulants or vitamin K antagonists, and it supplements the 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Non-Valvular Atrial Fibrillation, which covered the management of patients undergoing planned surgical or interventional procedures.

The new pathway, which was published in the Journal of the American College of Cardiology, offers flowcharts to guide clinician decision making. Issues addressed include the severity of the bleed (major versus nonmajor), relevant laboratory tests, acute medical and surgical management, need for reversal, appropriateness and timing of restarting anticoagulation, and the impact of pertinent comorbidities and concomitant drug therapy. The pathway authors also advised that patient-specific factors should be considered at each step and offered advice on clinician-patient discussions.

The article's preface also cautions that decision pathways “are not intended to provide a single correct answer, but to encourage clinicians to ask certain questions and consider important factors as they come to their own decision on a treatment plan to be recommended and discussed with their patients.” This pathway was based on scientific evidence and expert opinions gathered at the Anticoagulation Consortium Roundtable, held in 2016, and by subsequent review and deliberation on available evidence by the expert consensus writing committee.