Table 13.

TVARC Bleeding Classification

Type 1 Overt bleeding that is not actionable and does not cause the patient to seek unscheduled performance of studies, hospitalization, or treatment by a health care professional; may include episodes leading to self-discontinuation of medical therapy by the patient without consulting a health care professional

Type 2 Any overt, actionable sign of hemorrhage (eg, more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for type 3, 4, or 5 but does meet at least 1 of the following criteria: 1) requiring nonsurgical, medical intervention by a health care professional; 2) leading to hospitalization or increased level of care; or 3) prompting evaluation

Type 3

Type 3a Overt bleeding plus hemoglobin drop of 3 to <5 g/dLa (provided hemoglobin drop is related to bleed) Any transfusion with overt bleeding

Type 3b Overt bleeding plus hemoglobin drop ≥5 g/dLa (provided hemoglobin drop is related to bleed) Cardiac tamponade caused by bleeding into the pericardial space Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid) Bleeding requiring intravenous vasoactive agents

Type 3c Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal) Subcategories confirmed by autopsy or imaging or lumbar puncture Intraocular bleed compromising vision

Type 4: Thoracotomy or percutaneous entry-site related bleeding Perioperative intracranial bleeding within 48 h Reoperation after closure of entry site for the purpose of controlling bleeding Transfusion of ≥ 5 U whole blood or packed red blood cells within a 48-h periodb Chest tube output ≥ 2 L within a 24-h period

Type 5: Life-threatening bleeding

Type 5a Probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious Type 5b Definite fatal bleeding; overt bleeding or autopsy or imaging confirmation

^aCorrected for transfusion (1-U packed red blood cells or 1-U whole blood = 1 g/dL hemoglobin).

^bCell saver products are not counted. Adapted with permission from the Bleeding Academic Research Consortium.¹⁰⁶