Antithrombotic-associated bleeding: management in the emergency department

The expanding use of antiplatelet agents, anticoagulants, and fibrinolytics has made bleeding emergencies more frequent and more complex. A structured, evidence-based approach enables emergency clinicians to identify life-threatening and critical-site bleeding, initiate resuscitation, establish which antithrombotic agent the patient received and when, and weigh the benefit of restoring hemostasis against the risk for thrombosis. This review synthesizes current guidelines and evidence on the evaluation and management of bleeding in patients receiving antithrombotic therapy, identifying areas of consensus and ongoing uncertainty. Coagulation assays, agent-specific reversal and hemostatic strategies, periprocedural management, and bleeding in pregnancy are addressed.