Bleeding Risk Assessment Score for Outpatients on Warfarin
Outpatient Bleeding Risk Index
Beyth RJ, Quinn LM, Landefeld CS. Prospective evaluation of an index for predicting major bleeding in outpatients treated with warfarin. Am J Med. 1998;105:91-9.
Aspinall SL, DeSanzo BE, Trilli LE, et al. Bleeding Risk Index in an anticoagulation clinic. Assessment by indication and implications for care. J Gen Intern Med. 2005;20:1008-13.
| Risk Factor | Points Awarded |
|---|---|
| Age >= 65 | 1 |
| History of stroke | 1 |
| History of gastrointestinal bleeding | 1 |
| Presence of 1 or more comorbid conditions (recent MI; SCr > 1.5mg/dL; Hct < 30%; diabetes) |
1 |
| Bleeding Risk Group | Observed Outpatient Risk of Major Bleeding | Observed Outpatient Risk of Minor Bleeding |
|---|---|---|
| 0 points = Low Risk |
0.8 %/pt-yr | 8.5%/pt-yr |
| 1-2 points = Intermediate Risk | 2.6 %/pt-yr | 5.3 %/pt-yr |
| 3-4 points = High Risk |
9.7 %/pt-yr | 6.1 %/pt-yr |
HEMORR2HAGES
Gage BF, Yan Y Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillatiion. Am Heart J 2006; 151:713-9.
| Letter | Clinical Characteristic | Points Awarded |
|---|---|---|
| H | Hepatic or renal disease | 1 |
| E | Ethanol abuse | 1 |
| M | Malignancy | 1 |
| O | Older age (>75) | 1 |
| R | Reduced platelet count or function | 1 |
| R | Rebleeding risk (ie: prior bleed) | 2 |
| H | Hypertension, uncontrolled | 1 |
| A | Anemia | 1 |
| G | Genetic factors (CYP2C9 variant) | 1 |
| E | Excessive fall risk | 1 |
| S | Stroke | 1 |
| Risk Score | Incidence of Major Bleeding (%/pt-yr) |
|---|---|
| 0 | 1.9 |
| 1 | 2.5 |
| 2 | 5.3 |
| 3 | 8.4 |
| 4 | 10.4 |
| >=5 | 12.3 |
The HAS-BLED Score
Pisters R, Lane DA, Nieuwlaat R, deVos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation. The Euro Heart Survey. Chest 2010; 138:1093-1100
| Letter | Clinical Characteristic | Definition | Points Awarded |
|---|---|---|---|
| H | Hypertension | Uncontrolled; >160mmHg systolic | 1 |
| A | Abnormal renal and/or liver function (1 point each) | Renal: chronic dialysis, renal transplant, or Scr> 2 Liver: chronic hepatic disease or laboratory evidence |
1 or 2 |
| S | Stroke | Prior history of stroke | 1 |
| B | Bleeding | Bleeding histor, anemia, or predisposition to bleeding | 1 |
| L | Labile INRs | Therapeutic time-in-range < 60% | 1 |
| E | Elderly | Age > 65 | 1 |
| D | Drugs and/or alcohol | Drugs: concurrent antiplatelet agents or NSAIDS Alcohol: 8 or more drinks per week |
1 or 2 |
| Risk Score | Incidence of Major Bleeding In Euro Heart Survey Patients (%/pt-yr) |
|---|---|
| 0 | 1.13 |
| 1 | 1.02 |
| 2 | 1.88 |
| 3 | 3.74 |
| 4 | 8.7 |
| 5 | 12.5 |
| 6 | 0 bleeds/2 patients |
| 7 | 0 patients |
| 8 | 0 patients |
| 9 | 0 patients |