Subsequent Thromboembolic and Bleeding Events in Patients With Major Bleeding While on Factor Xa Inhibitors.

BACKGROUND: Management of patients after bleeding associated with Factor Xa inhibitors (FXa-I) remains challenging due to limited available data on unpredictable sequencing of bleeding and thromboembolic events. METHODS AND RESULTS: This cohort study identified 5,349 patients with FXa-I-related major bleeding. During the 360-day follow-up, bleeding events were highest in the first 90 days (42.2 per 100 person-years), declining to 18.6 by days 271-360. Conversely, thromboembolic events showed a reverse pattern, increasing from 17.3 to 28.6. CONCLUSIONS: Patients surviving FXa-I-related bleeding experience a risk transition from bleeding to thromboembolic risk, suggesting the need for time-dependent management strategies.