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Nasal and gastrointestinal bleeding: 3 case reports In a retrospective study of 439 patients who underwent atrial fibrillation (AF) ablation at Osaka Rosai Hospital enrolled between August 2017 and December 2018, three women (aged 68–77 years) were described, who developed nasal bleeding (1 woman) and gastrointestinal bleeding (2 women) during oral anticoagulant (OAC) therapy with apixaban, warfarin or rivaroxaban for atrial fibrillation (AF) [not all dosages and outcomes stated]. Case 1 (a 75-year-old woman): The woman, who had been receiving oral apixaban 5mg, twice daily for AF, from at least past three weeks, underwent AF ablation procedure. The full dose of anticoagulant therapy was continued during the peri-procedure period. She developed nasal bleeding one day after the procedure, which required intervention with an otorhinolaryngologist. Apixaban was therefore interrupted for 24 hours. Case 2 (a 68-year-old woman): The woman, who had been receiving oral warfarin for AF, from at least past three weeks, underwent AF ablation procedure. The full dose of anticoagulant therapy was continued during the peri-procedure period. The PTINR before the procedure was found to be 1.48. She developed gastrointestinal bleeding 30 days after the procedure. The PT-INR on the day of bleeding was 6.25. Warfarin was therefore reversed by vitamin-K. Four days after the bleeding event, warfarin was resumed, but without heparin bridge. Case 3 (a 77-year-old woman): The woman, who had been receiving oral rivaroxaban 10mg, once daily for AF, from at least past three weeks, underwent AF ablation procedure. The full dose of anticoagulant therapy was continued during the peri-procedure period. However, 21 days after the procedure, she developed gastrointestinal bleeding. Rivaroxaban treatment was however not interrupted. Matsunaga-Lee Y, et al. Clinical experience of uninterrupted oral anticoagulants during atrial fibrillation ablation in elderly patients: a comparison with non-elderly patients. 803503727 Heart and Vessels 35: 1454-1462, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1007/s00380-020-01615-y

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