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bleedingrisk

assessing major bleeding risk on anticoagulants

HAS-BLED

  • 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

Outpatient Bleeding Risk Index

  • 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
bleedingrisk.txt · Last modified: 2018/01/26 11:49 (external edit)