Clinical Assessment and Risk Stratification

The clinical presentation of the anticoagulated patient is largely similar regardless of the agent used. Patients may present with anything from minor mucosal bleeding to fatal intracranial bleeding. It is not uncommon to have an asymptomatic overcoagulated patient who is treated with warfarin, heparin infusions or have overdosed on any agent.

The classification of bleeding into minor and major varies widely.

Major bleeding can be described as bleeding associated with a significant risk of death (such as intracerebral bleeding, uncontrollable epistaxis, catastrophic gastrointestinal and genitourinary bleeding), bleeding associated with long-term morbidity (such as intraocular bleeding, intraarticular), bleeding requiring surgical intervention, or bleeding requiring blood transfusion. Minor bleeding can be regarded as any bleeding that is not major (such as haemoptysis, purpura, unexplained or excessive haematomas, epistaxis and mild haematuria) [4].

Anticoagulation can have significant sequelae causing death or serious morbidity, so being able to manage haemorrhage in the anticoagulated patient is essential.