Brazilian consensus on the management of bleeding complications related to the use of oral anticoagulants.

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.