Scoring Systems for Estimating the Risk of Anticoagulant‐Associated Bleeding

@article{Parks2017ScoringSF,
  title={Scoring Systems for Estimating the Risk of Anticoagulant‐Associated Bleeding},
  author={Anna L Parks and Margaret C. Fang},
  journal={Seminars in Thrombosis and Hemostasis},
  year={2017},
  volume={43},
  pages={514–524}
}
  • A. Parks, M. Fang
  • Published 30 March 2017
  • Medicine
  • Seminars in Thrombosis and Hemostasis
Abstract Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS‐BLED, ATRIA, and HEMORR2 HAGES risk assessment tools, and can be used to help estimate patients’ risk for bleeding on anticoagulants. These tools vary by… 
View on Wolters Kluwer
ncbi.nlm.nih.gov
13 Citations
Highly Influential Citations
1
Background Citations
2
Methods Citations
2

Figures and Tables from this paper

13 Citations

The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism: comment
TLDR
In patients with venous thromboembolism, having two or more of these risk factors was deemed high risk based on bleeding rate estimates from several studies and the scoring system was used to make recommendations for time-limited or extended treatment courses.
The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism: reply
TLDR
In this opinion, bleeding scores should mainly be used to drive the decision on the duration of anticoagulation beyond the first three months, a treatment period required for all patients with acute venous thromboembolism (VTE), regardless of the individual risk of bleeding.
Risk Stratification for Bleeding Complications in Patients With Venous Thromboembolism: Application of the HAS‐BLED Bleeding Score During the First 6 Months of Anticoagulant Treatment
TLDR
The addition of cancer as an independent bleeding risk factor merits consideration, possibly as part of the “B” criterion (“bleeding tendency or predisposition”) in patients with VTE.
Clinical Scoring Systems in Thrombosis and Hemostasis.
  • A. Cuker
  • Medicine
    Seminars in thrombosis and hemostasis
  • 2017
TLDR
This theme issue includes 12 articles on the application of CSSs to various disorders of bleeding and clotting, where they stand in the four-step development process, their strengths and limitations, and their applicability (real or potential) to clinical practice.
Pulmonary embolism: Care standards in 2018.
Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban.
Major bleeding during oral anticoagulant therapy associated with factor V activation by factor Xa
TLDR
How this pathway varies in the normal population and whether FXa‐mediated activation of FV is associated with major bleeding in patients on anticoagulant therapy are investigated.
Medical oncologists' and palliative care physicians' opinions towards thromboprophylaxis for inpatients with advanced cancer: a cross-sectional study.
TLDR
Canadian medical oncologists have higher odds of recommending thromboprophylaxis for inpatients with advanced cancer than PC physicians, and the drivers of these differing practices are warranted.
Long-term functional outcomes and mortality after hospitalization for extracranial hemorrhage.
TLDR
Clinical and research efforts should incorporate the long-term harms of ECH into decision-making and strategies to mitigate these effects, which were associated with significant and durable declines in independence and survival.
International Council for Standardization in Haematology Recommendations for Hemostasis Critical Values, Tests, and Reporting.
TLDR
The purpose of this ICSH document is to provide laboratory guidance for identifying hemostasis (coagulation) tests that have potential patient risk based on analysis, test result, and patient presentations, and critical result thresholds, and developing laboratory policies.
...
...

References

SHOWING 1-10 OF 80 REFERENCES
Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry.
TLDR
A risk score based on six variables documented at entry can identify VTE patients at low, intermediate, or high risk for major bleeding during the first three months of therapy.
Predictive value of the HAS-BLED and ATRIA bleeding scores for the risk of serious bleeding in a "real-world" population with atrial fibrillation receiving anticoagulant therapy.
TLDR
The findings reinforce the incremental usefulness of the simple HAS-BLED score over other published bleeding risk scores in patients with AF receiving anticoagulant therapy, and show significantly better prediction accuracy than the weighted ATRIA score.
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation
TLDR
The five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores and can provide a simple, easily remembered tool to support clinical decision making.
Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Impact of Time in Therapeutic Range on Contemporary Bleeding Risk Scores
TLDR
In conclusion, HAS-BLED categorised adjudicated major bleeding events in low-risk and high-risk patients appropriately, whilst ORBIT and ATRIA categorised most major bleeds into their ‘low-risk’ patient categories, leading to improved predictive performance for major bleeding.
Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin.
Validation of a score for predicting fatal bleeding in patients receiving anticoagulation for venous thromboembolism.
Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF).
Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin.
Poor predictive value of contemporary bleeding risk scores during long-term treatment of venous thromboembolism. A multicentre retrospective cohort study.
TLDR
Current available bleeding risk scores had only a modest predictive value for patients with VTE, and future studies should aim at the creation of a new prediction rule, in order to better define the risk of bleeding of VTE patients.
A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study.
...
...