Recurrent bleeding in patients with atrial fibrillation receiving anticoagulation: fundamental and promising aspects of research

Imomkulov Kh.D.; Kropacheva E.S.; Dobrovolsky A.B.; Panchenko E.P.

doi:https://doi.org/10.17116/Cardiobulletin20262102122

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Abstract:

The review discusses the problem of recurrent bleeding in patients with atrial fibrillation receiving anticoagulant therapy. Anticoagulation determines prognosis of life in patients with atrial fibrillation by preventing ischemic stroke and systemic embolisms. However, at least 15-20% of patients suffer recurrent hemorrhagic complications despite correction of all risk factors and anticoagulation changes. Searching for predictors of recurrent bleeding is extremely relevant, as there is currently no system for stratifying the risk of recurrent hemorrhagic complications. The review analyzes clinical data on the incidence of recurrent bleeding and systematizes risk factors. Some clinical risk factors are unmodifiable that leads to searching for laboratory markers. The review also highlights new possible mechanisms that are promising for study. Data of modern methods of fibrin structure visualization are presented. These findings confirm hypothesis of “unstable” clot as the cause of recurrent bleeding. Data on relationship between gene polymorphism and level of factors determining structure and stability of fibrin (factor XIII, alpha, beta, gamma chains of fibrinogen and fibrinolysis system) are presented.

Keywords:

atrial fibrillation

recurrent bleeding

anticoagulants

fibrinogen

fibrin

Factor XIII

fibrinolysis

Authors:

Imomkulov Kh.D.

Chazov National Medical Research Center of Cardiology, Moscow, Russia

ORCID: 0009-0003-5332-7912

Kropacheva E.S.

Chazov National Medical Research Center of Cardiology, Moscow, Russia

ORCID: 0000-0002-3092-8593

Dobrovolsky A.B.

Chazov National Medical Research Center of Cardiology, Moscow, Russia

ORCID: 0000-0001-5397-6857

Panchenko E.P.

Chazov National Medical Research Center of Cardiology, Moscow, Russia

ORCID: 0000-0002-9158-2522

Received:

03.02.2026

Accepted:

09.03.2026

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References:

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