Approach to Managing Easy Bruising

Initial Clinical Assessment

• The American College of Cardiology recommends considering reversal agents for major bleeding on oral anticoagulants, such as 4-factor PCC with vitamin K for warfarin, idarucizumab 5g IV for dabigatran, and andexanet alfa for apixaban/rivaroxaban 1
• The American Academy of Pediatrics suggests that patients on divalproex sodium require platelet monitoring every 6 months 4
• The Mayo Clinic recommends applying pressure 5-10 seconds to injection sites to minimize injection-related bruising 2, 3, 9

Laboratory Evaluation Algorithm

• The American College of Cardiology states that patients on anticoagulants, such as warfarin, DOACs, should be evaluated for liver disease, warfarin effect 1
• The Journal of Clinical Oncology suggests that patients with easy bruising may have acquired hemophilia A, and requires hematology consultation, may need corticosteroids, IVIG, or factor replacement 6, 7

Special Populations and Contexts

• The American Academy of Pediatrics recommends screening for von Willebrand disease and thrombocytopenia in cardio-facio-cutaneous syndrome patients with easy bruising 4, 5, 8
• The Journal of Clinical Oncology states that easy bruising may indicate immune-related thrombocytopenia or acquired hemophilia A in patients on immune checkpoint inhibitor therapy 6, 7