What is the HEMORR2HAGES risk model and how is it scored?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Several risk models have been introduced. The risk model called HEMORR2HAGES assigns points to risk factors, as follows [74] :

  • History of bleeding (2 points)

  • Hepatic or renal disease (1 point)

  • Alcohol abuse (1 point)

  • Malignancy (1 point)

  • Older age (>75 years) (1 point)

  • Reduced platelet count or function, including aspirin therapy (1 point)

  • Hypertension (1 point)

  • Anemia (1 point)

  • Genetic predisposition (1 point)

  • Excessive fall risk (1 point)

  • Stroke (1 point)

Using this scoring, the risks of a major bleeding event per 100 patient-years of warfarin therapy are as follows:

  • 0 points: 1.9%

  • 1 point: 2.5%

  • 2 points: 5.3%

  • 3 points: 8.4%

  • 4 points: 10.4%

  • 5 or more points: 12.3%

When the bleeding risk outweighs the benefit, avoidance of anticoagulation therapy in AF should be considered. In addition, because of its teratogenic effects, anticoagulation with warfarin is contraindicated in pregnant women, especially in the first trimester.


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