Restarting DOAC Too Early After a Serious Bleed May Be Risky
Restarting DOAC Too Early After a Serious Bleed May Be Risky
Medscape Medical News, July 31, 2025
Key Points:
1. Background:
• Doctors often struggle with when to restart blood thinners (DOACs) after a serious bleeding event in atrial fibrillation (AF) patients.
2. The Study:
• More than 10,000 patients in Denmark with serious bleeding events (intracranial, GI, or nasal) while on DOACs were analyzed.
• Two groups were compared:
– Early restart: Resumed DOACs within 60 days
– Late restart: Resumed DOACs after 60 days
3. Key Results:
• “There is little to gain by restarting DOACs too soon after a serious bleeding event.” — Dr. Nour Al-Hussainy (Study Lead)
4. Guideline Summary – When to Restart Anticoagulation (AF patients):
ESC 2020 and AHA/ACC/HRS 2023 recommend resuming oral anticoagulation based on bleeding type and individualized stroke vs. bleeding risk:
• GI bleeding: Restart after 7–14 days, once bleeding is controlled.
• Intracranial hemorrhage (ICH): Delay 4–8 weeks, depending on neurological recovery and risk factors.
→ Supported as Class IIa recommendation (moderate strength of evidence) in both guidelines.
