Nikolsky et al developed a prognostic score for predicting major bleeding in a patient undergoing a percutaneous coronary intervention (PCI) using the femoral approach. This can help identify a patient who may require aggressive management. The authors are from Columbia University, London School of Hygiene and Tropical Medicine and the Cleveland Clinic.
Criteria for major bleed - any of the following:
(1) intracranial
(2) intraocular
(3) retroperitoneal
(4) overt blood loss with hemoglobin drop > 3 g/dL
(5) need to transfusion 2 or more units of packed RBCs
(6) any decrease in hemoglobin > 4 g/dL
Parameters:
(1) age in years
(2) gender
(3) use of Glycoprotein IIb/IIIa inhibitors
(4) use of low molecular weight heparin in the 48 hours prior to PCI
(5) hematocrit (as a measure of anemia)
(6) estimated GFR based on serum creatinine
(7) use of an intra-aortic balloon pump (IABP)
|
Parameter |
Finding |
Points |
|
age in years |
<= 55 |
0 |
|
|
> 55 |
see below |
|
gender |
male |
0 |
|
|
female |
3 |
|
use of Glycoprotein inhibitors |
no |
0 |
|
|
yes |
3 |
|
low molecular weight heparin |
no |
0 |
|
|
yes |
2 |
|
hematocrit |
male and hematocrit >= 39% |
0 |
|
|
male and hematocrit < 39% |
2 |
|
|
female and hematocrit >= 37% |
0 |
|
|
female and hematocrit < 37% |
2 |
|
estimated GFR |
>= 60 mL per min per 1.73 square meter BSA |
0 |
|
|
< 60 mL per min per 1.73 square meter BSA |
2 |
|
use of an IABP |
no |
0 |
|
|
yes |
5 |
One approach to assign points for age is to give 3 points for 56 to 65 years, 6 for 66 to 75, 9 for 76 to 85, 12 for 86 to 95, 15 for 96 to 105, and 18 for 106 to 115.
An alternative method is:
points for age =
= MAX(0, 0.3 * ((age in years) - 55))
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 29+ (depends on age)
• The higher the score the greater the risk of a major bleed.
|
Total Score |
Risk for a Major Bleed |
|
0 |
1% |
|
2 to 6 |
1.5% |
|
7 to 9 |
2.6% |
|
10 or more |
5.4% |
Specialty: Cardiology
ICD-10: ,
