How is the bleeding risk from anticoagulation stratified in stroke prevention?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

A bleeding risk stratification scheme called HEMORR2 HAGES has been validated in at least a dataset of anticoagulated patients. The score is calculated as the sum of the following risk factors for bleeding:

  • Hepatic or renal disease

  • Ethanol abuse

  • Malignancy

  • Old age (>75 y)

  • Rebleeding

  • Reduced platelet counts or platelet dysfunction

  • Hypertension that is uncontrolled

  • Anemia

  • Genetic factors

  • Elevated fall risk

  • Stroke

All of the above risk factors are assigned a value of 1 point, except for rebleeding, which counts for 2 points.

The table below shows the incidence of major bleeding stratified by the HEMORR2 HAGES score (data from the National Registry of Atrial Fibrillation). [37]

Table 3. Bleeding risk stratification scheme [37] (Open Table in a new window)

HEMORR2 HAGES score

No. of patients

No. of bleeding

Bleeding per 100 patient-years warfarin (95% CI)

0

209

4

1.9 (0.6-4.4)

1

508

11

2.5 (1.3-4.3)

2

454

20

5.3 (3.4-8.1)

3

240

15

8.4 (4.9-13.6)

4

106

9

10.4 (5.1-18.9)

≥5

87

8

12.3 (5.8-23.1)

Any score

1604

67

4.9 (3.9-6.3)


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