Bleeding Risk Assessment Tool Bleeding Risk Factors Bleeding Risk Factor Points Age 65 years 1 History of Stroke 1 History of Gastrointestinal Bleed within last two weeks 1 One or more of the following (equals one): 1 Recent myocardial infarction Hematocrit <30 percent Serum creatinine concentration >1.5 mg/dl Diabetes mellitus Bleeding Risk Score Bleeding Risk Category 0 Low 1-2 Moderate 3+ High CHEST-2012 contains a more comprehensive list of bleeding risk factors, used to compare the relative risks of recurrent thromboembolism and bleeding with extended treatment vs. short-term treatment for VTE. These risk factors should also be taken into consideration in the setting of a high INR: Age 65+ failure Age 75+ Metastatic cancer Alcohol abuse Poor anticoagulant control Anemia Previous bleeding Antiplatelet therapy Previous stroke Cancer Recent surgery Diabetes Renal failure Comorbidity and reduced functional capacity Thrombocytopenia Frequent falls Application of Bleeding and Bleeding Risk Assessment to Clinical Scenarios: Clinical Scenario I: Patient is bleeding: INR Bleeding Risk Category Guideline Plan: bleeding All: critical actions Notify AMS MD of INR and clinical description of bleeding. with INR 5.0 AMS MD advises clinical action if evaluation or other action required. Omit the next dose or two and monitor INR before making additional adjustments; resume therapy at lower dose when the INR is within or approaching therapeutic range and clinically appropriate.
Bleeding Risk Assessment Tool Bleeding Risk Factors Bleeding Risk Factor Points Age 65 years 1 History of Stroke 1 History of Gastrointestinal Bleed within last two weeks 1 One or more of the following (equals one): Recent myocardial infarction Hematocrit <30 percent Serum creatinine concentration >1.5 mg/dl Diabetes mellitus 1 Bleeding Risk Score Bleeding Risk Category 0 Low 1-2 Moderate 3+ High CHEST-2012 contains a more comprehensive list of bleeding risk factors, used to compare the relative risks of recurrent thromboembolism and bleeding with extended treatment vs. short-term treatment for VTE. These risk factors should also be taken into consideration in the setting of a high INR: Age 65+ Age 75+ Alcohol abuse Anemia Antiplatelet therapy Cancer Diabetes Comorbidity and reduced functional capacity Frequent falls failure Metastatic cancer Poor anticoagulant control Previous bleeding Previous stroke Recent surgery Renal failure Thrombocytopenia Application of Bleeding and Bleeding Risk Assessment to Clinical Scenarios: Clinical Scenario I: Patient is bleeding: INR Bleeding Risk Category Guideline Plan: bleeding with INR 5.0 All: critical actions Notify AMS MD of INR and clinical description of bleeding. AMS MD advises clinical action if evaluation or other action required. Omit the next dose or two and monitor INR before making additional adjustments; resume therapy at lower dose when the INR is within or approaching therapeutic range and clinically appropriate.
AMS%20Guideline%20Revision-2012.050714.docx