Evaluation of Physicians’ Knowledge Regarding the Management of Anticoagulant-associated Bleeding: Cross-sectional Survey

Abstract Anticoagulants are widely used to prevent and treat thromboembolic events. Despite the growing utilization of direct oral anticoagulants (DOACs), there are still gaps in clinicians’ understanding of monitoring requirements and the management of DOAC-associated life-threatening bleeding. This study assessed the knowledge of hospital-based physicians regarding anticoagulant use and bleeding management in a tertiary hospital in Saudi Arabia. Methods: A cross-sectional survey was conducted among consultants, specialists, and residents from major medical specialties. A structured questionnaire evaluated knowledge of anticoagulant monitoring, pharmacokinetics, reversal agents, and management strategies. Descriptive statistics summarized responses, and chi-square tests compared consultants and residents, with P<0.05 considered significant. Results: A total of 252 physicians participated. Although 72% had previously managed life-threatening anticoagulant-related bleeding, only 55% had received formal training, and 34% felt confident managing such cases independently. Most participants identified INR as the appropriate test for warfarin monitoring, but fewer demonstrated adequate knowledge of DOAC and heparin assays. Substantial uncertainty existed regarding the selection and dosing of reversal agents such as prothrombin complex concentrate and idarucizumab. Consultants demonstrated significantly greater knowledge than residents across multiple domains (P<0.05). Conclusion: Physicians exhibited variable and often limited knowledge regarding DOAC monitoring and the management of severe anticoagulant-related bleeding. These findings highlight the need for targeted education, improved institutional guidelines, and anticoagulation stewardship initiatives to enhance clinical competency and patient safety.