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Sara Altayeb: ESC 2026 Clinical Pearls for Bleeding on Anticoagulation
Sara Altayeb/LinkedIn
Apr 13, 2026, 08:35

Sara Altayeb: ESC 2026 Clinical Pearls for Bleeding on Anticoagulation

Sara Altayeb, Internal Medicine Specialist at Virtual Sudan Clinic, shared on LinkedIn:

”Bleeding on Anticoagulation | ESC 2026 Clinical Pearls:

Managing bleeding isn’t just about stopping drugs, it’s about risk stratification plus targeted reversal plus safe restart.

1. Classify First (ESC Approach):

  • Minor / self-limited
  • Clinically relevant non-major (CRNM)
  • Major / Life-threatening

Severity drives everything!

2. What Defines Major Bleeding?

  • Hemodynamic instability
  • Hb drop ≥ 2 g/dL or transfusion ≥ 2 units
  • Critical site (intracranial, GI, retroperitoneal)

Treat immediately!!

3. Know Your Anticoagulant!

  • Warfarin (VKA) – check INR
  • DOACs – consider last dose + renal function
  • Heparin – short half-life (rapid offset)

Drug plus timing equals management strategy!

4. Management by Severity:

Minor:

  • Continue anticoagulant
  • Local measures only

CRNM:

  • Temporarily hold drug
  • Treat source
  • Review dose and interactions

Major Bleeding:

  • Stop anticoagulant
  • ABC resuscitation first
  • Use reversal

ESC Reversal Pearls:

  • Warfarin – PCC + Vitamin K
  • Dabigatran – Idarucizumab
  • Apixaban/Rivaroxaban – Andexanet alfa (if available) or PCC
  • Heparin – Protamine

5. Restarting Anticoagulation:

Restart early once hemostasis achieved

  • High thrombotic risk – restart sooner
  • Intracranial bleed – delay and individualize

‘Don’t forget why the patient was anticoagulated.’

Take-Home: Classify – Stabilize – Reverse (if needed) – Restart safely.”

Sara Altayeb: ESC 2026 Clinical Pearls for Bleeding on Anticoagulation

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Anticoagulation Apixaban bleeding DOACs ESC Health Hematology Hemostasis Hemostasis News Hemostasis Today Heparin Medicine Rivaroxaban Sara Altayeb thrombosis VKAs Warfarin
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