{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:45:56Z","timestamp":1790383556641,"version":"4.1.0"},"reference-count":181,"publisher":"Oxford University Press (OUP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite the clear net clinical benefit of oral anticoagulation (OAC) in atrial fibrillation (AF) patients at risk for stroke, major bleeding events (especially intra-cranial bleeds) may be devastating events when they do occur. The decision for OAC is often based on a careful assessment of both stroke risk and bleeding risk, but clinical scores for bleeding risk estimation are much less well validated than stroke risk scales. Also, the estimation of bleeding risk is rendered difficult since many of the known factors that increase bleeding risk overlap with stroke risk factors. As well as this, many factors that increase bleeding risk are transient, such as variable international normalized ratio values, operations, vascular procedures, or drug\u2013drug and food\u2013drug interactions.<\/jats:p>\n                  <jats:p>In this Position Document, we comprehensively review the published evidence and propose a consensus on bleeding risk assessments in AF patients, with a view to summarizing \u2018best practice\u2019 when approaching antithrombotic therapy in AF patients. We address the epidemiology and size of the problem of bleeding risk in AF and review established bleeding risk factors. We also summarize definitions of bleeding in the published literature. Patient values and preferences balancing the risk of bleeding against thrombo-embolism is reviewed, and the prognostic implications of bleeding are discussed. We also review bleeding risk stratification and currently published bleeding risk schema. A brief discussion of special situations [e.g. peri-ablation, peri-devices (implantable cardioverter-defibrillator, pacemakers) and presentation with acute coronary syndromes and\/or requiring percutaneous coronary interventions\/stents and bridging therapy], as well as a discussion of prevention of bleeds and managing bleeding complications, is made. Finally, this document also puts forwards consensus statements that may help to define evidence gaps and assist in everyday clinical practice.<\/jats:p>\n                  <jats:p>Bleeding risk is almost inevitably lower than stroke risk in patients with atrial fibrillation. Nonetheless, identification of patients at high risk of bleeding and delineation of conditions and situations associated with bleeding risk can help to refine antithrombotic therapy to minimize bleeding risk.<\/jats:p>","DOI":"10.1093\/europace\/eur126","type":"journal-article","created":{"date-parts":[[2011,4,22]],"date-time":"2011-04-22T12:18:00Z","timestamp":1303474680000},"page":"723-746","source":"Crossref","is-referenced-by-count":182,"title":["Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis"],"prefix":"10.1093","volume":"13","author":[{"given":"Gregory Y.H.","family":"Lip","sequence":"first","affiliation":[{"name":"University of Birmingham Centre for Cardiovascular Sciences 1 , , Birmingham B18 7QH ,","place":["UK"]},{"name":"City Hospital 1 , , Birmingham B18 7QH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicita","family":"Andreotti","sequence":"additional","affiliation":[{"name":"\u2018A. Gemelli\u2019 University Hospital 2 Department of Cardiovascular Medicine , , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Fauchier","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire Trousseau et Universit\u00e9 Fran\u00e7ois Rabelais 3 Cardiologie B , , Tours ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"Cardiology and Emergency Medicine 4 3rd Department of Medicine , , , A-1160 Vienna ,","place":["Austria"]},{"name":"Wilhelminenhospital 4 3rd Department of Medicine , , , A-1160 Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Hylek","sequence":"additional","affiliation":[{"name":"Boston University Medical Center 5 Department of Medicine, Research Unit-Section of General Internal Medicine , , Boston, MA 02118 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eve","family":"Knight","sequence":"additional","affiliation":[{"name":"6 AntiCoagulation, Europe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deirdre A.","family":"Lane","sequence":"additional","affiliation":[{"name":"University of Birmingham Centre for Cardiovascular Sciences 1 , , Birmingham B18 7QH ,","place":["UK"]},{"name":"City Hospital 1 , , Birmingham B18 7QH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Levi","sequence":"additional","affiliation":[{"name":"University of Amsterdam 7 Department of Medicine, Academic Medical Center , , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Marin","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen de la Arrixaca 8 Department of Cardiology , , Murcia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gualtiero","family":"Palareti","sequence":"additional","affiliation":[{"name":"University Hospital S. Orsola-Malpighi 9 Department of Angiology and Blood Coagulation , , Bologna ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum M\u00fcnster 10 Department of Cardiology and Angiology , , D-48149 M\u00fcnster ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Document reviewers:","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Philippe","family":"Collet","sequence":"additional","affiliation":[{"name":"Groupe Hopitalier Pitie-Salpetriere 11 , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rubboli","sequence":"additional","affiliation":[{"name":"12 Maggiore Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Poli","sequence":"additional","affiliation":[{"name":"Thrombosis Center 13 Department of Heart and Vessels , , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Camm","sequence":"additional","affiliation":[{"name":"St.George's University of London 14 Division of Cardiac and Vascular Sciences , , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2011,5,1]]},"reference":[{"key":"2026081001073597700_EUR126C1","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1093\/eurheartj\/ehm358","article-title":"Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA)","volume":"28","author":"Kirchhof","year":"2007","journal-title":"Eur Heart J"},{"key":"2026081001073597700_EUR126C2","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1093\/europace\/euq350","article-title":"Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)","volume":"12","author":"Camm","year":"2010","journal-title":"Europace"},{"key":"2026081001073597700_EUR126C3","doi-asserted-by":"crossref","first-page":"297","DOI":"10.7326\/0003-4819-151-5-200909010-00003","article-title":"The net clinical benefit of warfarin anticoagulation in atrial fibrillation","volume":"151","author":"Singer","year":"2009","journal-title":"Ann Intern 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