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. Author manuscript; available in PMC: 2012 Jul 19.
Published in final edited form as: J Am Coll Cardiol. 2011 Jul 19;58(4):395–401. doi: 10.1016/j.jacc.2011.03.031

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

  • Age ≥ 65 years (1 point)

  • Prior stroke (1 point)

  • Prior GI bleeding (1 point)

  • Recent myocardial infarction, diabetes mellitus, Hematocrit<30%, creatinine>1.5 mg/dL (1 point if any of the above)

 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

  • Age > 60 years (1.6 pts)

  • Female sex (1.3 pts)

  • Presence of malignancy (2.2 pts)

 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)

  • Age ≥ 65 years (1 point)

  • Prior stroke (1 point)

  • Prior peptic ulcer disease (1 point)

  • Prior GI bleeding (1 point)

  • Creatinine>1.5 mg/dL (1 point)

  • Anemia or Thrombocytopenia (1 point)

  • Liver disease (1 point)

  • Diabetes mellitus (1 point)

  • Antiplatelet therapy (1 point)

 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

  • Hepatic or renal disease (1 point)

  • Ethanol abuse (1 point)*

  • Malignancy (1 point)

  • Older age > 75 years (1 point)

  • Reduced platelet count or function (1 point)*

  • Rebleeding risk (2 point)

  • Hypertension (1 point)

  • Anemia (1 point)

  • Genetic factors (1 point)*

  • Excessive fall risk or neuropsychiatric disease (1 point)

  • Stroke (1 point)

 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

  • Age ≥ 70 years

  • Female sex

  • Remote bleeding event

  • Recent bleeding event

  • Alcohol or drug abuse*

  • Diabetes mellitus

  • Anemia (Hct<30% during index hospitalization)

  • Antiplatelet drugs (aspirin, clopidogrel, or ticlodipine at discharge)*

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

  • Recent major bleeding (<15 days prior to thrombotic event) (2 points)

  • Creatinine > 1.2 mg/dL (1.5 points)

  • Anemia (1.5 points)

  • Malignancy (1 point)

  • Clinically overt pulmonary embolism* (1 point)

  • Age > 75 years (1 point)

 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