Electroconvulsive therapy (ECT) can be an effective treatment for certain severe mental-health conditions, such as depression or bipolar disorder. Facilities may have understandable concerns about its use for people with bleeding disorders, especially because ECT can carry a small risk of bleeding in the brain (intracranial hemorrhage).

National guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC)—in Document 289 (approved October 2024)—confirms that ECT can be safely used in people with bleeding disorders with the right planning and precautions.

MASAC notes that:

• There are documented case reports of individuals with severe hemophilia A who have undergone ECT safely and successfully.

• Research also supports the safety of ECT among people receiving anticoagulant therapy, which carries similar bleeding considerations.

To minimize risk, MASAC strongly recommends that the mental-health team coordinate with the bleeding-disorder treatment team before starting ECT.
Together, the teams should develop a plan to provide hemostatic protection—similar to what would be used before a major surgical procedure—before each ECT session.

With proper communication, shared planning, and individualized care, ECT can be safe for individuals with bleeding disorders when clinically indicated.

Reassuring Facilities About ECT and Bleeding Disorders

• “I understand your team may be concerned about the safety of using ECT for someone with a bleeding disorder, especially because of the risk of intracranial bleeding—that’s completely valid.”

• “According to national guidance from the National Bleeding Disorders Foundation’s Medical and Scientific Advisory Council (MASAC), ECT can be safely used in people with bleeding disorders as long as proper precautions are in place.”

• “This recommendation comes directly from MASAC Document 289, approved October 2024.”

• “There are published case reports of people with severe hemophilia A who have undergone ECT safely, as well as studies showing it can be safely used in people on anticoagulant therapy.”

• “To reduce any bleeding risk, MASAC recommends that your team consult with my bleeding-disorder treatment team in advance of starting ECT.”

• “My treatment team can help develop a plan that includes hemostatic medication before each ECT session—similar to how we prepare for a major surgical procedure.”

• “We’re committed to working together so I can receive the most effective psychiatric treatment while staying medically safe and stable.”

• “My treatment team is available to help coordinate timing, dosing, and any needed monitoring to make the process as smooth and safe as possible.”

Send the following to the facility:

• Guidance on Electroconvulsive Therapy (ECT) and Bleeding Disorders: Personalize this email template to request provide the facility with MASAC guidance on electroconvulsive therapy for people with bleeding disorders.

• Medical and Scientific Advisory Council (MASAC) of the National Bleeding Disorders Foundation, summarized in Document 289 (approved October 2024).

• Considerations for use of ECT for persons with bleeding disorders