assessing major bleeding risk on anticoagulants

see also:

• atrial fibrillation
• anticoagulants

• originally derived from the Euro Heart survey evaluating risk of hemorrhage in patients with atrial fibrillation using warfarin
• Score 1 point for each:
  • hypertension if either uncontrolled or > 160mmHgsystolic
  • severe renal disease (dialysis, transplant, CRN > 2.26mg/dL or 200umol/L)
  • severe liver disease (cirrhosis, bilirubin > twice normal, AST, ALT or AP > 3x normal)
  • PH stroke
  • Prior major bleeding event or predisposition to bleeding
  • labile INR on warfarin (unstable or high INRs, or INR in Rx zone < 60% of time)
  • age > 65yrs
  • medication risks - antiplatelets (aspirin, clopidogrel, etc) or non-steroidal anti-inflammatory drugs (NSAIDs)
  • substance abuse - especially alcohol > 8 drinks per week
• interpretation:
  • score < 1 = low risk, consider anticoagulation in AF if indicated
  • score 2 = moderate bleeding risk, consider anticoagulation in AF if indicated
  • score > 3 = high risk, consider alternative to anticoagulation in AF

• a score used in patients with VTE based on using heparin and warfarin
• Score 1 point for each:
  • age > 65 yrs
  • history of stroke
  • history of GIT bleeding
  • serious comorbid condition (recent AMI, CRN > 1.5mg/dL, severe anaemia haematocit < 30%, diabetes)
  • AF
• interpretation:
  • score 0 = low risk (3% risk of bleed)
  • score 1 or 2 = mod risk
  • score 3 or higher = high risk (30% risk of bleed)
  • The higher the points on each score, the more consideration is needed regarding whether the patient should be started on anticoagulation