Bleeding risk assessment and management in atrial fibrillation patients

Gregory Y. H. Lip; Felicita Andreotti; Laurent Fauchier; Kurt Huber; Elaine Hylek; Eve Knight; Deirdre Lane; Marcel Levi; Francisco Marin; Gualtiero Palareti; Paulus Kirchhof; J.-P. Collet; A. Rubboli; D. Poli; A. J. Camm

doi:10.1160/TH11-10-0690

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(06): 997-1011.
DOI: 10.1160/TH11-10-0690

Position Paper

Schattauer GmbH

Bleeding risk assessment and management in atrial fibrillation patients

Executive Summary^[#] of a Position Document from the European Heart Rhythm Association [EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on Thrombosis

Gregory Y. H. Lip^*

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

,

Felicita Andreotti^**

²Department of Cardiovascular Medicine, “A. Gemelli” University Hospital, Rome, Italy

,

Laurent Fauchier

³Cardiologie B, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France

,

Kurt Huber^**

⁴3rd Dept of Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria

,

Elaine Hylek

⁵Department of Medicine, Research Unit-Section of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA

,

Eve Knight

⁶Patient Representative, AntiCoagulation Europe, Bromley, UK

,

Deirdre Lane

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

,

Marcel Levi

⁷Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

,

Francisco Marin

⁸Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

,

Gualtiero Palareti

⁹Department of Angiology and Blood Coagulation, University Hospital S. Orsola-Malpighi, Bologna, Italy

,

Paulus Kirchhof^***

⁵Department of Medicine, Research Unit-Section of General Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA

,

J.-P. Collet

,

A. Rubboli

,

D. Poli

,

A. J. Camm

› Author Affiliations

Abstract

Summary

In this executive summary of a Consensus Document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in atrial fibrillation (AF) patients. The main aim of the document was to summarise ‘best practice’ in dealing with bleeding risk in AF patients when approaching antithrombotic therapy, by addressing the epidemiology and size of the problem, and review established bleeding risk factors. We also summarise definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thromboembolism as well as the prognostic implications of bleeding are reviewed. We also provide an overview of published bleeding risk stratification and bleeding risk schema. Brief discussion of special situations (e.g. periablation, peri-devices such as implantable cardioverter defibrillators [ICD] or pacemakers, presentation with acute coronary syndromes and/or requiring percutanous coronary interventions/stents and bridging therapy) is made, as well as a discussion of the prevention of bleeds and managing bleeding complications. Finally, this document puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice.

Keywords

Bleeding - oral anticoagulation - atrial fibrillation - risk assessment

Full Text

References

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