Optimizing care for patients after major anticoagulant-related bleeding: a narrative review and proposal for a clinical care pathway

Oral anticoagulation, although effective for the treatment and prevention of thromboembolic events, increases the risk of major bleeding. The acute management phase of anticoagulant-related major bleeding requires rapid decision-making and often involves multiple medical specialties. Guidelines offer some guidance for the acute management phase, most notably on strategies for anticoagulant reversal, but there are still uncertainties about how to organize optimal aftercare. In this narrative review, we examine the different aspects of aftercare from both clinicians’ and patients’ perspectives, including the resumption of anticoagulation, its timing, risk factor modification, and patient-reported outcomes. Finally, we present a dedicated clinical care pathway for survivors with anticoagulant-related major bleeding.