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Point-of-Care Guides

Bleeding Risk in Patients 80 Years and Older Taking a Direct Oral Anticoagulant

Mark Ebell, MD, MS

American Family Physician. 2026;113(3):285-286.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor's Note.

This clinical content conforms to AAFP criteria for CME.

MARK EBELL, MD, MS, Michigan State University, East Lansing, Michigan

Address correspondence to Mark Ebell, MD, MS, at ebell@msu.edu.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor's Note.

  1. 1.Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest. 2018;154(5):1121-1201.
  2. 2.January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-132.
  3. 3.Wazni OM, Saliba WI, Nair DG, et al.; OPTION Trial Investigators. Left atrial appendage closure after ablation for atrial fibrillation. N Engl J Med. 2025;392(13):1277-1287.
  4. 4.Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-1100.
  5. 5.Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-719.
  6. 6.Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin- associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study. J Am Coll Cardiol. 2011;58(4):395-401.
  7. 7.O'Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36(46):3258-3264.
  8. 8.Caldeira D, Costa J, Fernandes RM, et al. Performance of the HAS-BLED high bleeding-risk category, compared to ATRIA and HEMORR2HAGES in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2014;40(3):277-284.
  9. 9.Chang G, Xie Q, Ma L, et al. Accuracy of HAS-BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: a network meta-analysis. J Thromb Haemost. 2020;18(4):791-801.
  10. 10.Aggarwal R, Ruff CT, Virdone S, et al. Development and validation of the DOAC score: a novel bleeding risk prediction tool for patients with atrial fibrillation on direct-acting oral anticoagulants. Circulation. 2023;148(12):936-946.
  11. 11.Mei DA, Imberti JF, Bonini N, et al. Performance of HAS-BLED and DOAC scores to predict major bleeding events in atrial fibrillation patients treated with direct oral anticoagulants: a report from a prospective European observational registry. Eur J Intern Med. 2024;128:63-70.
  12. 12.Krebs L, Saguil A. Predicting bleeding risk in patients with atrial fibrillation who are taking direct oral anticoagulants. Am Fam Physician. 2024;110(6):639-640.
  13. 13.Piccoli M, Pisica-Donose G, Hacil A, et al. A new bleeding risk score specifically developed for direct oral anticoagulants in a geriatric population. Age Ageing. 2025;54(6):afaf118.
  14. 14.Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke. 2006;37(6):1583-1633.

This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-making at the point of care.

This series is coordinated by Mark H. Ebell, MD, MS, deputy editor for evidence-based medicine.

A collection of Point-of-Care Guides published in AFP is available at https://www.aafp.org/afp/poc.

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