Bleeding risk assessment and management in atrial fibrillation patients. Key messages for clinical practice from the European Heart Rhythm Association position statement

Abstract

The prevention of thromboembolism is the main therapeutic goal in patients with atrial fibrillation (AF). Vitamin K antagonists have been proved highly effective in preventing thromboembolic events in patients with AF and despite recent advances in oral anticoagulation they remain the most widely used agents. Anticoagulation increases the incidence of bleeding; however, in the field of stroke prevention in AF the clinical benefit of vitamin K antagonists clearly outweighs potential risks. The annual incidence of major bleeding among individuals with AF on oral anticoagulation varies widely, ranging from 1.3% to 7.2%. Several factors affect bleeding risk including the intensity of anticoagulation, the efficacy of monitoring modalities, and patient characteristics. This multifactorial etiology makes prediction of bleeding risk complex, necessitating the derivation and validation of clinical prediction tools for the estimation of total bleeding risk in clinical practice. The present review summarizes data on definition, risk prediction, prevention, and management of oral anticoagulation‑associated bleeding as reflected by the recent European Heart Rhythm Association consensus statement.