Renato Delascio Lopes, Pedro Gabriel Melo de Barros E Silva, Remo Holanda de Mendonça Furtado, Ariane Vieira Scarlatelli Macedo, João Carlos de Campos Guerra, Ana Thereza Cavalcanti Rocha, Joyce Maria Annichino Bizzacch, Writing Committee for the SBTH Consensus Collaboration, Executive Committee, Renato Delascio Lopes, Pedro Gabriel Melo de Barros E Silva, Remo Holanda de Mendonça Furtado, Ariane Vieira Scarlatelli Macedo, João Carlos de Campos Guerra, Ana Thereza Cavalcanti Rocha, Joyce Maria Annichino Bizzacch, Collaborators, Alexandre Coutinho Teixeira de Freitas, Antonio Carlos da Silva Moraes, Bernardo Pinheiro de Senna Nogueira Batista, Christiane Soares Poncinelli, Fábio Guilherme Caserta Maryssael de Campos, Liana Maria Tôrres de Araujo Azi, Lucas Oliveira Junqueira E Silva, Luciana Ferreira Franco, Maramelia Miranda Alves, Mauro Goldbaum, Ricardo Caponero, Ricardo Pavanello, Rogerio da Hora Passos, Roni de Carvalho Fernandes, Sheila Martins, Suely Meireles Rezende, Tomaz Crochemore, Valquíria Pelisser Campagnucci, Venina Isabel Poço Viana Leme de Barros
Management of bleeding in patients receiving oral anticoagulants requires rapid clinical assessment, severity stratification, targeted reversal strategies, and multidisciplinary care. Individualized reassessment of thrombotic versus hemorrhagic risk is essential to optimize outcomes and guide safe reintroduction of anticoagulation therapy after bleeding resolution.
OBJECTIVE: To provide practical, evidence-based guidance for the evaluation and management of bleeding complications associated with oral anticoagulations, including vitamin K antagonists and direct oral anticoagulants, with emphasis on reversal strategies, supportive care, and safe resumption of anticoagulation.
METHODS: This Brazilian multidisciplinary consensus was developed by the Brazilian Society of Thrombosis and Hemostasis (SBTH) based on contemporary international guidelines and the best available scientific evidence. Recommendations were reviewed by a multidisciplinary panel of experts and adapted to the Brazilian clinical setting and local resource availability.
RESULTS: The document proposes a structured stepwise approach for the management of oral anticoagulation-related bleeding, including initial stabilization, bleeding severity assessment, laboratory evaluation, temporary interruption of anticoagulation, and indication of reversal or hemostatic therapies in patients with major bleeding and significant circulating anticoagulant levels. Specific management strategies are detailed according to anticoagulant class, including idarucizumab for dabigatran and andexanet alfa or prothrombin complex concentrates for factor Xa inhibitors. The consensus also emphasizes multidisciplinary follow-up and individualized decision-making regarding anticoagulation resumption after bleeding control.
CONCLUSION: Management of bleeding in patients receiving oral anticoagulants requires rapid clinical assessment, severity stratification, targeted reversal strategies, and multidisciplinary care. Individualized reassessment of thrombotic versus hemorrhagic risk is essential to optimize outcomes and guide safe reintroduction of anticoagulation therapy after bleeding resolution.