Montalescot et al listed criteria for major and minor bleeding during heparin therapy. The authors are the STEEPLE investigators from Europe and North America.


Number of Major Bleeding Criteria

Number of Minor Bleeding Criteria

Classification of Bleeding

>= 1

>= 0



>= 1






Major bleeding criteria:

(1) bleeding that is fatal

(2) bleeding into critical sites: retroperitoneum, intracranial, intraocular

(3) bleeding sufficient to cause significant hypotension (hemodynamic compromise) requiring specific therapy

(4) bleeding that requires decompression or an intervention to control bleeding

(5) clinically overt bleeding requiring transfusion of >= 1 units of packed RBCs

(6) clinically overt bleeding resulting in a decrease in hemoglobin >= 3 g/dL (>= 10% drop in hematocrit)


Minor bleeding criteria:

(1) gross hematuria not associated with trauma or instrumentation (spontaneous bleeding)

(2) epistaxis that is prolonged, recurrent or requires an intervention for control

(3) gastrointestinal bleeding

(4) hemoptysis

(5) subconjunctival hemorrhage

(6) hematoma > 5 cm in diameter that results in hospitalization or prolongation of current hospitalization

(7) clinically overt bleeding resulting in a decrease in hemoglobin from 2-3 g/dL (6 -9% drop in hematocrit)

(8) uncontrolled bleeding requiring administration of protamine sulfate


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