Table 1. Risk Stratification Schemes Used to Predict Warfarin-Associated Hemorrhage.
Risk Scheme | Risk Factors | Risk Category | Points | Major Bleeding Rate in Validation Cohorts |
---|---|---|---|---|
Outpatient Bleeding Index (Beyth et al, 1998 modification of bleeding index developed by Landefeld and Goldman)(5) Developed in patients newly starting warfarin after hospital discharge |
|
Low | 0 | 3% at 12 months |
Intermediate | 1-2 | 8% at 12 months | ||
High | 3-4 | 30% at 12 months | ||
Kuijer et al, 1999(6) Developed in patients with acute thromboembolism |
|
Low | 0 | 0.6% at 3 months |
Intermediate | >0 and <3 | 2% at 3 months | ||
High | ≥ 3 | 7% at 3 months | ||
Kearon et al, 2003(7) Developed in patients with acute venous thromboembolism enrolled in a clinical trial†. Risk score categories developed and validated by Gage et al.(8) |
|
Low | 0-1 | 2.5 per 100 person-years |
Intermediate | 2 | 6.5 per 100 person-years | ||
3 | 9.3 per 100 person-years | |||
High | ≥ 4 | 15.3 per 100 person-years | ||
HEMORR2HAGES (Gage et al, 2006)(8) Developed in hospitalized Medicare patients with atrial fibrillation discharged on warfarin |
|
Low | 0-1 | 1.9-2.5 per 100 person-years |
Intermediate | 2-3 | 5.3-8.4 per 100 person-years | ||
High | ≥ 4 | 10.4-12.3 per 100 person-years | ||
Shireman et al, 2006(9) Developed in hospitalized Medicare patients with atrial fibrillation discharged on warfarin | Risk score= 0.49(age≥70)+0.32(female) +0.58(remote bleed)+0.62(recent bleed)+0.71(alcohol/drug abuse)+0.27(diabetes) +0.86(anemia)+ 0.32(antiplatelet use) | Low | ≤ 1.07 | 0.9% within 90 days |
Intermediate | > 1.07 and < 2.19 | 2.0% within 90 days | ||
High | ≥ 2.19 | 5.4% within 90 days | ||
RIETE risk scheme (Ruiz-Gimenez et al, 2008)(10) Developed in patients with acute venous thromboembolism |
|
Low | 0 | 0.1% at 3 months |
Intermediate | 1-4 | 2.8% at 3 months | ||
High | > 4 | 6.2% at 3 months |
Data on ethanol abuse, drug abuse, aspirin, and genetic factors not available in ATRIA database
Hemorrhage rates when risk scheme applied to Gage et al. atrial fibrillation cohort(8)
Abbreviations: GI=gastrointestinal