Bleeding Complications During Anticoagulation Therapy for Atrial Fibrillation and Their Association with Subsequent Diagnosis of Malignancy: A Comprehensive Review

Abstract Anticoagulation therapy is a cornerstone in the management of atrial fibrillation (AF) to prevent thromboembolic events. However, bleeding complications, ranging from minor to life- threatening, are a significant concern. Emerging evidence suggests that bleeding events in patients on anticoagulants may be an early indicator of underlying malignancy, particularly gastrointestinal, genitourinary, and hematologic cancers. This article provides a comprehensive review of the pathophysiology, clinical presentation, diagnostic approaches, and management strategies for bleeding during anticoagulation in AF patients, with a focus on its association with subsequent malignancy. We discuss diagnostic imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopy, and their role in identifying bleeding sources and uncovering occult malignancies. Recommendations for clinical practice and future research directions are also provided.