Priority 2 from the Bleeding Disorder PSP

UNCERTAINTY: How can we balance the risk and benefit of antithrombotic (blood thinning) treatment for cardiovascular disease (including heart attacks and strokes) in patients with bleeding disorders? (JLA PSP Priority 2)
Overall ranking	2
JLA question ID	0078/2
Explanatory note	Patients with bleeding orders are not protected from development of arterial disease and atrial fibrillation which usually require anticoagulation or antiplatelet therapy. These therapies incur an increased risk of bleeding which will be more marked in patients with bleeding disorders. It is therefore very important to find the right balance between protecting patients from heart attacks and stroke and inducing a risk of bleeding which might also be fatal.
Evidence	Harahsheh Y, Ho KM. Use of viscoelastic tests to predict clinical thromboembolic events: A systematic review and meta-analysis. Eur J Haematol. 2018;100(2):113-23.Whiting P, Al M, Westwood M, Ramos IC, Ryder S, Armstrong N, et al. Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2015;19(58):1-228, v-vi
Health Research Classification System category	Blood

Extra information provided by this PSP
Original uncertainty examples	Management of bleeding disorder patients with cardiovascular disease eg how should we approach patients with bleeding disorders who have AF and high CHADSVASC scores? ~ How should patients with inherited bleeding disorders and atrial fibrillation be managed? ~ How should patients with inherited bleeding disorders and acute coronary syndrome be managed?
Submitted by	Not available

PSP information
PSP unique ID	0078
PSP name	Bleeding Disorders
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	7 July 2018