Managing bleeds on anticoagulant therapy: a practical guide for clinicians

Bleeding is a prevalent and frequently serious complication of anticoagulant therapy. The use of oral anticoagulants to prevent thrombotic events in common cardiovascular conditions, such as atrial fibrillation, exposes patients to an increased risk of bleeding which is associated with morbidity and mortality. The consequences of bleeding extend well beyond the acute event, affecting treatment adherence, long-term management decisions, and increasing the risk of ischaemic events when anticoagulation is discontinued. Optimizing the balance between thrombotic and bleeding risk requires expertise in risk stratification, preventive strategies, acute management, and the appropriate timing of anticoagulation resumption after haemostasis. This review summarizes the epidemiology and clinical impact of bleeding in patients receiving oral anticoagulant therapy and provides contemporary, patient-centred flowcharts for acute management and safe resumption of treatment. Future efforts should focus on refining risk prediction, individualizing anticoagulant regimens, and improving access to targeted reversal agents to further improve patient outcomes.