Management of Antithrombotic Therapy after Bleeding in Patients with Coronary Artery Disease and/or Atrial Fibrillation: Expert Consensus Paper of the ESC WG Thrombosis

Bleeding is a frequent complication of the management of patients with coronary artery disease (CAD), especially those presenting with acute coronary syndromes or undergoing percutaneous coronary intervention. Randomised trials have shown a risk of major bleeding of 1-8% at 30-days in ACS patients. Observational studies suggest that bleeding risk is even higher. Major bleeding is associated with a subsequent increase in both short- and long-term mortality.

Although several recommendations have been published dealing with the acute management of bleeding in patients treated with antithrombotic drugs, there is an unmet need for guidance on how to manage antithrombotic therapy after bleeding has occurred. The aim of this position paper was to offer a European perspective on management of antithrombotic therapy after major bleeding in patients with CAD and/or AF, including which drugs to stop, which to restart, and when.

In the paper we provide guidance on how to manage antiplatelet treatment after bleeding in patients with CAD, how to manage antithrombotic treatment after bleeding in patients in need of both antiplatelets and oral anticoagulants, as well as some suggestions on how to manage antithrombotic therapy in CAD patients after intracranial bleeds.Whenever possible we strongly suggest recruiting patients into randomised trials or registries designed to address the many dilemmas.