{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:06:31Z","timestamp":1784549191848,"version":"3.55.0"},"reference-count":40,"publisher":"FapUNIFESP (SciELO)","issue":"6","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: To provide practical, evidence-based guidance for the evaluation and management of bleeding complications associated with oral anticoagulations, including vitamin K antagonists and direct oral anticoagulants, with emphasis on reversal strategies, supportive care, and safe resumption of anticoagulation.  METHODS: This Brazilian multidisciplinary consensus was developed by the Brazilian Society of Thrombosis and Hemostasis (SBTH) based on contemporary international guidelines and the best available scientific evidence. Recommendations were reviewed by a multidisciplinary panel of experts and adapted to the Brazilian clinical setting and local resource availability.  RESULTS: The document proposes a structured stepwise approach for the management of oral anticoagulation-related bleeding, including initial stabilization, bleeding severity assessment, laboratory evaluation, temporary interruption of anticoagulation, and indication of reversal or hemostatic therapies in patients with major bleeding and significant circulating anticoagulant levels. Specific management strategies are detailed according to anticoagulant class, including idarucizumab for dabigatran and andexanet alfa or prothrombin complex concentrates for factor Xa inhibitors. The consensus also emphasizes multidisciplinary follow-up and individualized decision-making regarding anticoagulation resumption after bleeding control.  CONCLUSION: Management of bleeding in patients receiving oral anticoagulants requires rapid clinical assessment, severity stratification, targeted reversal strategies, and multidisciplinary care. Individualized reassessment of thrombotic versus hemorrhagic risk is essential to optimize outcomes and guide safe reintroduction of anticoagulation therapy after bleeding resolution.<\/jats:p>","DOI":"10.1590\/1806-9282.20252032","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:26:20Z","timestamp":1784546780000},"source":"Crossref","is-referenced-by-count":0,"title":["Brazilian consensus on the management of bleeding complications related to the use of oral anticoagulants"],"prefix":"10.1590","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-4961","authenticated-orcid":false,"given":"Renato Delascio","family":"Lopes","sequence":"first","affiliation":[{"name":"Duke University School of Medicine,  United Sates; Brazilian Clinical Research Institute,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1940-4470","authenticated-orcid":false,"given":"Pedro Gabriel Melo de Barros e","family":"Silva","sequence":"additional","affiliation":[{"name":"Brazilian Clinical Research Institute,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4639-1003","authenticated-orcid":false,"given":"Remo Holanda de Mendon\u00e7a","family":"Furtado","sequence":"additional","affiliation":[{"name":"Brazilian Clinical Research Institute,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3453-8488","authenticated-orcid":false,"given":"Ariane Vieira Scarlatelli","family":"Macedo","sequence":"additional","affiliation":[{"name":"Sociedade Brasileira de Trombose e Hemostasia,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5794-4454","authenticated-orcid":false,"given":"Jo\u00e3o Carlos de Campos","family":"Guerra","sequence":"additional","affiliation":[{"name":"Einstein Hospital Israelita,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-2598","authenticated-orcid":false,"given":"Ana Thereza Cavalcanti","family":"Rocha","sequence":"additional","affiliation":[{"name":"Universidade Federal da Bahia Escola Bahiana de Medicina e Sa\u00fade P\u00fablica,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1434-1071","authenticated-orcid":false,"given":"Joyce Maria Annichino","family":"Bizzacch","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Campinas,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato Delascio","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Gabriel Melo de Barros e","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remo Holanda de Mendon\u00e7a","family":"Furtado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane Vieira Scarlatelli","family":"Macedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Carlos de Campos","family":"Guerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Thereza Cavalcanti","family":"Rocha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce Maria Annichino","family":"Bizzacch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Coutinho Teixeira de","family":"Freitas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Carlos da Silva","family":"Moraes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Pinheiro de Senna Nogueira","family":"Batista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane Soares","family":"Poncinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1bio Guilherme Caserta Maryssael de","family":"Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana Maria T\u00f4rres de Araujo","family":"Azi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Oliveira Junqueira e","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana Ferreira","family":"Franco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maramelia Miranda","family":"Alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Goldbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Caponero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Pavanello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogerio da Hora","family":"Passos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roni de Carvalho","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suely Meireles","family":"Rezende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomaz","family":"Crochemore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valqu\u00edria Pelisser","family":"Campagnucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venina Isabel Po\u00e7o Viana Leme de","family":"Barros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5334\/gh.1288","article-title":"The heart of the world","volume":"19","author":"Cesare M","year":"2024","journal-title":"Glob Heart"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"e545","DOI":"10.1016\/j.chest.2021.07.055","article-title":"Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report","volume":"160","author":"Stevens SM","year":"2021","journal-title":"Chest"},{"issue":"36","key":"ref3","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation","volume":"45","author":"Gelder IC","year":"2024","journal-title":"Eur Heart J"},{"issue":"38","key":"ref4","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne RA","year":"2023","journal-title":"Eur Heart J"},{"issue":"36","key":"ref5","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints C","year":"2024","journal-title":"Eur Heart J"},{"issue":"36","key":"ref6","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC Guidelines for the management of peripheral arterial and aortic diseases","volume":"45","author":"Mazzolai L","year":"2024","journal-title":"Eur Heart J"},{"issue":"5","key":"ref7","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/EJA.0000000000001968","article-title":"Clinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding","volume":"41","author":"Grottke O","year":"2024","journal-title":"Eur J Anaesthesiol"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1093\/europace\/euab065","article-title":"2021 EHRA practical guide on the use of non-vitamin K antagonist oral anticoagulants","volume":"23","author":"Steffel J","year":"2021","journal-title":"Europace"},{"issue":"9921","key":"ref9","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(13)62343-0","article-title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials","volume":"383","author":"Ruff CT","year":"2014","journal-title":"Lancet"},{"issue":"5","key":"ref10","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey","volume":"138","author":"Pisters R","year":"2010","journal-title":"Chest"},{"issue":"5","key":"ref11","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1183\/13993003.00280-2016","article-title":"Prediction of bleeding events in patients with venous thromboembolism on stable anticoagulation treatment","volume":"48","author":"Klok FA","year":"2016","journal-title":"Eur Respir J"},{"issue":"12","key":"ref12","doi-asserted-by":"crossref","first-page":"e884","DOI":"10.1016\/S2352-3026(20)30327-6","article-title":"Safety of direct oral anticoagulant exposure during pregnancy: a retrospective cohort study","volume":"7","author":"Beyer-Westendorf J","year":"2020","journal-title":"Lancet Haematol"},{"issue":"12","key":"ref13","first-page":"e977","article-title":"2026 AHA\/ACC\/ACCP\/ACEP\/CHEST\/SCAI\/SHM\/SIR\/SVM\/SVN Guideline for the evaluation and management of acute pulmonary embolism in adults: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"153","author":"Creager MA","year":"2026","journal-title":"circulation"},{"issue":"7651","key":"ref14","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1136\/bmj.39490.551019.BE","article-title":"What is \"quality of evidence\" and why is it important to clinicians?","volume":"336","author":"Guyatt GH","year":"2008","journal-title":"BMJ"},{"issue":"7650","key":"ref15","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt GH","year":"2008","journal-title":"BMJ"},{"key":"ref16","series-title":"Defining the role of authors and contributors [Internet]","year":"2026"},{"issue":"20","key":"ref17","doi-asserted-by":"crossref","first-page":"2230","DOI":"10.1001\/jama.2009.1669","article-title":"Requirements and definitions in conflict of interest policies of medical journals","volume":"302","author":"Blum JA","year":"2009","journal-title":"JAMA"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"100165","DOI":"10.1016\/j.tru.2024.100165","article-title":"A framework for managing severe DOAC- related bleeding: recognize, reverse, resume, reduce","volume":"15","author":"Cormier S","year":"2024","journal-title":"Thromb Update"},{"issue":"Suppl C","key":"ref19","doi-asserted-by":"crossref","first-page":"C15","DOI":"10.1093\/eurheartjsupp\/suad004","article-title":"Management of bleeding in patients on direct oral anticoagulants in emergency department: where we are and where we are going","volume":"25","author":"Marco F","year":"2023","journal-title":"Eur Heart J Suppl"},{"issue":"5","key":"ref20","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.jacc.2020.04.053","article-title":"2020 ACC Expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology solution set oversight committee","volume":"76","author":"Tomaselli GF","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"23","key":"ref21","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran R","year":"2011","journal-title":"Circulation"},{"issue":"1","key":"ref22","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1182\/hematology.2019000072","article-title":"What we have learned about direct oral anticoagulant reversal","volume":"2019","author":"Siegal DM","year":"2019","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"Suppl 1","key":"ref23","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/ijlh.12658","article-title":"The danger of relying on the APTT and PT in patients on DOAC therapy, a potential patient safety issue","volume":"39","author":"Adcock, DM","year":"2017","journal-title":"Int J Lab Hematol"},{"issue":"2","key":"ref24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0171272","article-title":"Determination of rivaroxaban in patient's plasma samples by anti-Xa chromogenic test associated to High Performance Liquid Chromatography tandem Mass Spectrometry (HPLC-MS\/MS)","volume":"12","author":"Derogis PB","year":"2017","journal-title":"PLoS One"},{"issue":"4","key":"ref25","doi-asserted-by":"crossref","DOI":"10.1590\/1414-431x20198006","article-title":"Diagnostic accuracy of thromboelastometry and its correlation with the HPLC-MS\/MS quantification test","volume":"52","author":"Aranda VF","year":"2019","journal-title":"Braz J Med Biol Res"},{"issue":"1","key":"ref26","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13017-024-00572-5","article-title":"Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort","volume":"20","author":"Dupuy C","year":"2025","journal-title":"World J Emerg Surg"},{"issue":"4","key":"ref27","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1111\/bjh.18275","article-title":"Haematological management of major haemorrhage: a British Society for Haematology Guideline","volume":"198","author":"Stanworth SJ","year":"2022","journal-title":"Br J Haematol"},{"issue":"6","key":"ref28","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/bjh.15524","article-title":"The use of viscoelastic haemostatic assays in the management of major bleeding: a British Society for Haematology Guideline","volume":"182","author":"Curry NS","year":"2018","journal-title":"Br J Haematol"},{"key":"ref29","doi-asserted-by":"crossref","DOI":"10.31744\/einstein_journal\/2020AO5032","article-title":"Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil","volume":"18","author":"Jaures M","year":"2020","journal-title":"Einstein (Sao Paulo)"},{"issue":"2","key":"ref30","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.htct.2024.01.002","article-title":"Hemorrhagic code protocol, a successful case in the patient blood management model for patients with severe hemorrhages","volume":"46","author":"Guerra JCC","year":"2024","journal-title":"Hematol Transfus Cell Ther"},{"issue":"1","key":"ref31","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s13054-019-2347-3","article-title":"The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition","volume":"23","author":"Spahn DR","year":"2019","journal-title":"Crit Care"},{"issue":"5","key":"ref32","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1213\/ANE.0b013e3182a52876","article-title":"Is dilutional coagulopathy induced by different colloids reversible by replacement of fibrinogen and factor XIII concentrates?","volume":"117","author":"Kind SL","year":"2013","journal-title":"Anesth Analg"},{"issue":"5","key":"ref33","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/MEJ.0000000000001049","article-title":"Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement","volume":"30","author":"Backus B","year":"2023","journal-title":"Eur J Emerg Med"},{"issue":"4","key":"ref34","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/EJA.0000000000001803","article-title":"Management of severe peri-operative bleeding: guidelines from the European Society of Anaesthesiology and Intensive Care: second update 2022","volume":"40","author":"Kietaibl S","year":"2023","journal-title":"Eur J Anaesthesiol"},{"issue":"1","key":"ref35","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13054-023-04327-7","article-title":"The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition","volume":"27","author":"Rossaint R","year":"2023","journal-title":"Crit Care"},{"issue":"4","key":"ref36","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/ACO.0000000000001275","article-title":"Direct oral anticoagulants and their antagonists in perioperative practice","volume":"36","author":"Levy JH","year":"2023","journal-title":"Curr Opin Anaesthesiol"},{"issue":"10","key":"ref37","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1001\/jamaneurol.2019.2099","article-title":"Clinical effectiveness of direct oral anticoagulants vs warfarin in older patients with atrial fibrillation and ischemic stroke: findings from the patient-centered research into outcomes stroke patients prefer and effectiveness research (PROSPER) study","volume":"76","author":"Xian Y","year":"2019","journal-title":"JAMA Neurol"},{"issue":"4","key":"ref38","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.007633","article-title":"Frequency and outcomes of reduced dose non-vitamin K antagonist anticoagulants: results from ORBIT-AF II (The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II)","volume":"7","author":"Steinberg BA","year":"2018","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"ref39","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/europace\/eux087","article-title":"Non-vitamin K-dependent oral anticoagulants have a positive impact on ischaemic stroke severity in patients with atrial fibrillation","volume":"20","author":"Hellwig S","year":"2018","journal-title":"Europace"},{"issue":"10104","key":"ref40","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S0140-6736(17)32165-7","article-title":"A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial","volume":"390","author":"Vinereanu D","year":"2017","journal-title":"Lancet"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302026000602205&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:26:25Z","timestamp":1784546785000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302026000602205&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026]]}},"alternative-id":["S0104-42302026000602205"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20252032","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2026]]},"article-number":"e20252032"}}