Franco et al evaluated bleeding in patients being treated with anticoagulants. They proposed a prognostic classification and compared it to that of the International Society of Thrombosis and Haemostasis (ISTH). The authors are from multiple institutions in Italy and Germany.

Patient selection: bleeding while on an oral anticoagulant


Outcome: life-threatening with risk of 30-day mortality


Criteria for life-threatening bleed (Grade III):

(1) intracerebral hemorrhage AND Glasgow coma score < 14

(2) non-intracerebral hemorrhage AND shock or hypotension

(3) non-intracerebral hemorrhage AND pericardial bleeding


Criteria for severe bleed (Grade II):

(1) intracerebral hemorrhage AND Glasgow coma score 14 or 15

(2) non-intracerebral hemorrhage AND major bleeding (see below) AND NOT hypotensive



• Major bleeding criteria of the ISTH not covered by other Grades include: (1) fall in hemoglobin >= 2 g/dL; (2) transfusion of >= 2 units of packed red blood cells; or(3) bleeding into a critical location (spinal, intramuscular with compartment syndrome, retroperitoneal)


Criteria for serious bleed (Grade I):

(1) intra-articular

(2) intra-ocular

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