Management of Anticoagulant Therapy in Athletes and Sportspeople: Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies (FCSA) Position Paper

This position paper offers expert guidance on managing anticoagulant therapy in athletes and sportspeople, addressing the unique challenges posed by the dual need for effective thromboprophylaxis and maintenance of athletic performance. Recognizing that conditions such as atrial fibrillation and venous thromboembolism occur with higher prevalence in athletes due to factors like intense physical training, dehydration, trauma, and long-haul travel, the paper reviews current literature and expert opinions from the Italian Federation of Centers for Diagnosis and Surveillance of the Antithrombotic Therapies. The manuscript highlights that although direct oral anticoagulants (DOACs) are generally preferred for their favorable efficacy and safety profile compared with traditional vitamin K antagonists (VKAs), their use in sports demands careful risk stratification. To balance effective anticoagulation with the risk of bleeding, individualized treatment strategies-including intermittent dosing regimens with DOACs-are suggested. These strategies aim to minimize bleeding risk during periods of high physical demand while preserving therapeutic effectiveness. In athletes requiring VKA therapy, sport participation-especially contact or high-impact activities-should be strongly discouraged due to the inability to manage bleeding and thrombotic risks safely. Moreover, the paper emphasizes the importance of periodic re-assessment of thromboembolic and hemorrhagic risks, multidisciplinary collaboration among cardiologists, hematologists, and sports medicine specialists, and shared decision-making with the athlete. By offering practical suggestions on treatment modifications, return-to-play protocols, and patient education, this position paper serves as a critical resource for clinicians striving to optimize anticoagulant therapy in athletic populations without compromising competitive performance.