Postbleeding antithrombotic management in cardiovascular patients: insights from the Attica Bleeding Snapshot study

Bleeding complications in cardiovascular patients receiving antithrombotic therapy pose a major clinical challenge, particularly given the limited evidence guiding antithrombotic management after a bleeding event.

This snapshot study aimed to evaluate the burden of major bleeding events requiring hospitalization and to describe real-world practices in postbleeding antithrombotic management.

The Attica Bleeding Snapshot was a multicenter, cross-sectional observational study conducted from February 17 to 21, 2025, in the Internal Medicine and Gastroenterology Departments of 17 hospitals in the Attica region, Greece. Adult patients hospitalized for major bleeding while receiving antithrombotic therapy for cardiovascular indications were included. Data collected comprised demographics, comorbidities, antithrombotic regimens, bleeding site, management strategies, and in-hospital outcomes.

Of 1540 hospitalized patients, 134 (8.7%) experienced major bleeding while on antithrombotic therapy. The mean ± SD age was 79.5 ± 11.1 years, and 38.1% were female. Atrial fibrillation was the most frequent indication for antithrombotic therapy (46.2%), followed by coronary artery disease (20.9%). Gastrointestinal bleeding accounted for 63.5% of cases. In-hospital mortality was 14.9%, with frailty independently associated with mortality (odds ratio, 1.64; 95% CI, 1.24-2.16; P < .001). Approximately one-third of patients were discharged without antithrombotic therapy, irrespective of ischemic risk.

Major bleeding during antithrombotic treatment is associated with substantial morbidity and mortality in cardiovascular patients. Postbleeding antithrombotic management remains highly heterogeneous, underscoring a critical unmet need. Alternative strategies for thromboembolic prevention, including left atrial appendage occlusion, merit consideration in selected high-risk atrial fibrillation patients, particularly those with recurrent bleeding.