Antithrombotic-Associated Bleeding: Management in the Emergency Department

Points & Pearls Excerpt

• Evaluation of the anticoagulated patient with bleeding should focus on 3 essential questions: Is the bleeding life-threatening or at a critical site? Which antithrombotic was taken, at what dose, and when was the last dose taken? And what is the benefit of improved hemostasis weighed against the risk of reversal?
• Resuscitation, including airway management, hemorrhage control, and hemodynamic support, must begin immediately and should not be delayed; anticoagulation reversal is a parallel consideration, not the first priority.
• Diagnosis of critical-site bleeding requires timely, site-directed imaging; modality selection should be guided by the suspected bleeding location.