For non-life-threatening bleeds, follow the left side of the figure.

The determination of life-threatening versus non-life-threatening bleeding is a clinical decision based on patient stability and circumstances.

Examples of minor bleeding include most cases of epistaxis, ecchymosis, and heavy menstrual bleeding.

Most of these bleeds can be managed through temporary drug discontinuation and local hemostatic measures.

• Drug discontinuation should weigh the balance between reducing bleeding and the risk of thromboembolism, ideally done in concert with expert consultation
  • Dose reduction may also be considered with expert consultation
• Tranexamic acid should be considered, notably for recurrent bleeding
• Local interventions to stop bleeding should also be considered, depending on the risk of the procedure

If bleeding continues and there is clinical deterioration, ( See question #4)

References:

1. Piran S, Khatib R, Schulman S, et al. Management of direct factor Xa inhibitor-related major bleeding with prothrombin complex concentrate: a meta-analysis. Blood Adv. 2019;3:158-167.
2. Schulman S. Bleeding Complications and Management on anticoagulant therapy. Semin Thromb Hemost. 2017;43:886-892.
3. Shih AW, Crowther MA. Reversal of Direct Oral Anticoagulants: A Practical Approach. Hematology Am Soc Hematol Educ Program. 2016;612-619.