Most studies examining the safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation have focused on major, life-threatening bleeding events. However, clinically relevant non-major bleeding (CRNMB) may lead to unnecessary prolonged withdrawal of DOACs, both by the patient and the physician, and, as a result, increase the risk of death and/or systemic thromboembolic complications. The article presents several classifications of types of bleeding: BARC, GARFIELD-AF, ISTH. An analysis of modern literature was carried out, as a result of which it was revealed that the incidence of CRNMB is higher than major bleeding and varies from 6.69% to 17.4%, the density of events for CRNMB was maximum 22.7 cases (95% confidence interval [16.3–30.8] per 100 patient-years) and the frequency of such bleeding had a direct relationship with the age of the patients studied: the older the population, the more frequent episodes of CRNMB occurred. The most common localization of CRNMB was in the gastrointestinal tract – up to 47%, genitourinary tract – up to 32.6% and skin – up to 17.6%. Based on the recommendations of leading cardiological societies to prevent bleeding, in addition to the HAS-BLED scale, additional prevention methods are presented, taking into account the age characteristics of the patient. As a current approach in the treatment of bleeding, it is recommended to determine the severity, identify and eliminate the source of bleeding. Discontinuation of DOACs during bleeding requires a personalized approach and, most importantly, prompt resumption of DOACs. At the same time, CRNMBoften require discontinuation of only one dose of the drug. Given that studies rarely present data on the incidence and pattern of CRNMB or data are presented in conjunction with other types of bleeding, it would be advisable that future studies regarding the safety of DOACs include more detailed information on the incidence of CRNMB, risk factors for its development, especially in geriatric patient populations.

Keywords: DOAC safety, clinically relevant non-major bleeding (CRNMB), direct oral anticoagulants (DOACs), elderly patient, adverse drug reactions, atrial fibrillation