Prevention and treatment of bleeding related to antithrombotic drugs

Abstract Antiplatelet and anticoagulant therapy reduce the occurrence of ischaemic events both in primary and secondary prevention in different cardiovascular conditions. However, these benefits come at the expense of higher bleeding complications, especially when different types of antithrombotic medications are combined. For decades, bleeding was thought to be an unavoidable side effect of antithrombotic therapy and of marginal relevance compared to ischaemic events. Yet, in recent years, major bleeding has been proven to impact mortality to a similar extent as ischaemic events. For these reasons, adoption of bleeding avoidance strategies is pivotal in the management of patients on antithrombotic therapy. These include an upfront bleeding risk assessment, accurate selection of candidates for invasive procedures, prevention of vascular access-related bleeding, modulation of antithrombotic therapy, and regular monitoring follow-up visits to reassess the bleeding risk and adjust the treatment. In case of bleeding, prompt treatment including reversal of antithrombotic treatment is required.