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Subsequent Thromboembolic and Bleeding Events in Patients With Major Bleeding While on Factor Xa Inhibitors
Takahiro Suzuki1,2, Masahiro Yasaka3, Fumitaka Wada4
1Department of Cardiology, Keio University School of Medicine Tokyo Japan.
Circulation Reports
|August 11, 2026
Summary
Patients surviving major bleeding from Factor Xa inhibitors (FXa-I) face a shift from bleeding to clotting risks. Management strategies must adapt over time to address these changing risks after FXa-I-related bleeding.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Managing patients post-bleeding from Factor Xa inhibitors (FXa-I) is complex.
- Limited data exists on the unpredictable sequence of bleeding and thromboembolic events.
Purpose of the Study:
- To analyze the temporal risk transition from bleeding to thromboembolic events in patients after major bleeding associated with FXa-I.
Main Methods:
- A cohort study included 5,349 patients with FXa-I-related major bleeding.
- Follow-up was conducted over 360 days.
Main Results:
- Bleeding event rates were highest within the first 90 days (42.2 per 100 person-years), decreasing to 18.6 by days 271-360.
- Thromboembolic event rates showed an inverse trend, increasing from 17.3 to 28.6 per 100 person-years over the same period.
Conclusions:
- Patients surviving FXa-I-related bleeding undergo a risk transition.
- This transition shifts from a primary bleeding risk to a subsequent thromboembolic risk.
- Time-dependent management strategies are crucial for optimizing patient care post-FXa-I bleeding.
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