IMPROVE Bleeding Risk Score for Inpatient on a Medical Service

Description

An inpatient should be evaluated for bleeding risk before being placed on prophylaxis against deep vein thrombosis. The IMPROVE score can help to identify a medical inpatient who is at increased risk for bleeding based on comorbid conditions. The author are from multiple institutions and are participants in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).

Patient selection: adult, admitted to a medical service, without bleeding on admission

Outcome: major bleeding or nonmajor bleeding that is clinically relevant

Parameters:

(1) age in years

(2) gender

(3) renal function (based on GFR in mL per minute per 1.73 square meters BSA)

(4) current cancer

(5) rheumatic disease

(6) central venous catheter

(7) in ICU or CCU

(8) hepatic failure (with INR > 1.5)

(9) platelet count

(10) history of bleeding in the 3 months prior to admission

(11) active gastroduodenal (peptic) ulcer

Parameter	Finding	Points
age in years	< 40 years	0
	40 to 84 years	1.5
	>= 85 years	3.5
gender	female	0
	male	1
renal function	GFR >= 60 mL per min per 1.73 square meters	0
	GFR 30 to 59	1
	GFR < 30	2.5
current cancer	no	0
	yes	2
rheumatic disease	no	0
	yes	2
central venous catheter	no	0
	yes	2
ICU or CCU	no	0
	yes	2.5
hepatic failure	no	0
	yes	2.5
platelet count	>= 50,000 per µL	0
	< 50,000 per µL	4
history of bleeding	no	0
	yes	4
active gastroduodenal ulcer	no	0
	yes	4.5

total score =

= SUM(points for all 11 parameters)

Interpretation:

• minimum score: 0

• maximum score: 30.5

• A patient with score >= 7.0 is at increased risk for bleeding.

• The results of the score can help the clinician how to approach thromboprophylaxis in a particular patient.

Score	Major Bleeding	Major or Clinically Relevant
0 to 6.5	0.4%	1.5%
>= 7.0	4.1%	7.9%

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Description

Specialty

Objective

ICD-10

IMPROVE Bleeding Risk Score for Inpatient on a Medical Service

Purpose: To evaluate a medical inpatient for risk of bleeding based on the IMPROVE bleeding risk score.

Description

Specialty

Objective

ICD-10