Arrhythmias & electrophysiology
Timing of anticoagulation restart after serious bleeding in atrial fibrillation
Main finding · StrokeResult — go to the resultHazard ratio 0.89 95% CI 0.74–1.08Authors' conclusion
Restarting DOACs early after a serious bleeding event in AF patients may reduce stroke risk but is associated with an increased risk of recurrent bleeding. DOAC monotherapy appears to offer the best stroke protection, though with elevated bleeding risk. These findings highlight the need for individualised decision-making and further trials to define optimal timing for DOAC resumption.
Study context
- Population
- Atrial fibrillation (AF) patients (CHA₂DS₂-VASc score ≥2) who experienced a first serious bleeding event while on DOAC therapy, Danish registries 2012–2021patients who survived 60 days postbleeding
- Participants
- 10,291 patients
- Exposure
- Timing of DOAC restart: within 60 days vs after 60 days
- Early restartersn = 5,970
- Late restartersn = 4,321reference
- Outcome
- Stroke
Methodological detailsmultivariable Cox models, secondary analysis across six time-varying antithrombotic treatment regimens
- Multivariable Cox models
- Secondary analysis across six time-varying antithrombotic treatment regimens
Main finding
As reported in the abstract
Hazard ratio
0.89
95% CI 0.74–1.08
Early restartersvs late restarters
HR 0.89 (95% CI 0.74–1.08)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Stroke (time-varying analysis)DOAC monotherapyvs no treatmentReduced stroke risk with DOAC monotherapy | 0.78 (0.68–0.89) | |
| 0.512Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Recurrent bleedingEarly restartersvs late restartersMore frequent in early restarters | 1.21 (1.07–1.36) | |
| Bleeding (time-varying analysis)DOAC monotherapyvs no treatmentHigher during DOAC monotherapy | 1.26 (1.15–1.38) | |
| 0.512Hazard ratio (log scale) |
Original publication
Timing of anticoagulation restart after serious bleeding in atrial fibrillation. Heart. Published 16 July 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →