What factors increase the risk of bleeding with anticoagulation in patients with atrial fibrillation (Afib) (AF)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Optimal long-term strategies for AF management should be based on a thoroughly integrated consideration of patient-specific factors and the likelihood of success. Selection of an appropriate antithrombotic regimen should be balanced between the risk of stroke and the risk of bleeding.

Factors that increase the risk of bleeding with anticoagulation include the following:

  • History of bleeding (the strongest predictive risk factor)

  • Age older than 75 years

  • Liver or renal disease

  • Malignancy

  • Thrombocytopenia or aspirin use

  • Hypertension

  • Diabetes mellitus

  • Anemia

  • Prior stroke

  • Fall risk

  • Genetic predisposition

  • Supratherapeutic INR (for warfarin)

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