Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism: Executive Summary of a European and Asia-Pacific Expert Consensus Paper
Por:
Gorog, DA, Gue, YX, Chao, TF, Fauchier, L, Ferreiro, JL, Huber, K, Konstantinidis, SV, Lane, DA, Marin, F, Oldgren, J, Potpara, T, Roldan, V, Rubboli, A, Sibbing, D, Tse, HF, Vilahur, G, Lip, GYH
Publicada:
1 oct 2022
Ahead of Print:
1 jul 2022
Resumen:
While there is a clear clinical benefit of oral anticoagulation in patients with atrial fibrillation (AF) and venous thromboembolism (VTE) in reducing the risks of thromboembolism, major bleeding events (especially intracranial bleeds) may still occur and be devastating. The decision for initiating and continuing anticoagulation is often based on a careful assessment of both thromboembolism and bleeding risk. The more common and validated bleeding risk factors have been used to formulate bleeding risk stratification scores, but thromboembolism and bleeding risk factors often overlap. Also, many factors that increase bleeding risk are transient and modifiable, such as variable international normalized ratio values, surgical procedures, vascular procedures, or drug-drug and food-drug interactions. Bleeding risk is also not a static "one-off" assessment based on baseline factors but is dynamic, being influenced by aging, incident comorbidities, and drug therapies. In this executive summary of a European and Asia-Pacific Expert Consensus Paper, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in patients with AF and VTE, with a view to summarizing "best practice" when approaching antithrombotic therapy in these patients. We address the epidemiology and size of the problem of bleeding risk in AF and VTE, and review established bleeding risk factors and summarize definitions of bleeding. Patient values and preferences, balancing the risk of bleeding against thromboembolism, are reviewed, and the prognostic implications of bleeding are discussed. We propose consensus statements that may help to define evidence gaps and assist in everyday clinical practice.
Filiaciones:
Gorog, DA:
Univ Hertfordshire, Sch Life & Med Sci, Postgrad Med Sch, Hatfield, Herts, England
Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England
Gue, YX:
Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Chao, TF:
Taipei Vet Gen Hosp, Div Cardiol, Dept Med, Taipei, Taiwan
Natl Yang Ming Chiao Tung Univ, Inst Clin Med, Taipei, Taiwan
Natl Yang Ming Chiao Tung Univ, Cardiovasc Res Ctr, Taipei, Taiwan
Fauchier, L:
Univ Tours, Fac Med, Tours, France
Ferreiro, JL:
Hosp Univ Bellvitge, Dept Cardiol, Lhospitalet De Llobregat, Spain
Ciber Cardiovasc CIBERCV, Lhospitalet De Llobregat, Spain
Inst Invest Biomed Bellvitge IDIBELL, BIOHEART Cardiovasc Dis Grp, Cardiovasc Resp & Syst Dis & Cellular Aging, Lhospitalet De Llobregat, Spain
Huber, K:
Wilhelminenhospital, Dept Med 3, Cardiol & Intens Care Med, Vienna, Austria
Sigmund Freud Univ, Fac Med, Vienna, Austria
Konstantinidis, SV:
Gutenberg Univ, Ctr Thrombosis & Hemostasis, Univ Med Ctr Johannes, Mainz, Germany
Lane, DA:
Aalborg Univ, Dept Clin Med, Aalborg, Denmark
Marin, F:
Univ Murcia, Hosp Clin Univ Virgen Arrixaca IMIB Arrixaca, Dept Cardiol, CIBERCV, Murcia, Spain
Oldgren, J:
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden
Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Potpara, T:
Univ Belgrade, Sch Med, Belgrade, Serbia
Roldan, V:
Univ Murcia, Hosp Univ Morales Meseguer, Serv Hematol, IMIB Arrixaca, Murcia, Spain
Rubboli, A:
S Maria Croci Hosp, Div Cardiol, Dept Cardiovasc Dis AUSL Romagna, Ravenna, Italy
Sibbing, D:
Ludwig Maximilians Univ Munchen, Dept Cardiol, Munich, Germany
Partner Site Munich Heart Alliance, DZHK German Ctr Cardiovasc Res, Munich, Germany
Tse, HF:
Univ Hong Kong, Div Cardiol, Dept Med, Hong Kong, Peoples R China
Vilahur, G:
Res Inst Hosp Santa Creu Sant Pau, IIB Sant Pau, Barcelona, Spain
CIBERCV Inst Salud Carlos III, Barcelona, Spain
Lip, GYH:
Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
Aalborg Univ, Dept Clin Med, Aalborg, Denmark
Bronze
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