UW Medicine Anticoagulation Services

Bleeding Risk Assessment for Outpatients

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

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