HEMORR2HAGES Score for Predicting Hemorrhage with Atrial Fibrillation

Description

Gage et al reported the HEMORR2HAGES score to help to identify a patient with atrial fibrillation who is at risk for excessive bleeding during antithrombotic therapy. Recognition of bleeding risk can be helpful in guiding patient management. The authors are from Washington University and Yale-New Haven Health.

Parameters:

(1) hepatic or renal disease (H)

(2) ethanol abuse (E)

(3) malignancy (M)

(4) older age (O)

(5) reduced platelet count or function (R)

(6) repeat hemorrhage or prior bleed or rebleeding risk (R2)

(7) hypertension (H) if uncontrolled

(8) anemia (A)

(9) genetic factors (G) such as CYP2C9 single nucleotide polymorphism

(10) excessive fall risk (E)

(11) stroke (S)

Parameter	Finding	Points
hepatic or renal disease	absent	0
	present	1
ethanol abuse	absent	0
	present	1
malignancy	absent	0
	present	1
older age	age <= 75 years)	0
	age > 75 years	1
reduced platelet count or function	absent	0
	present	1
prior bleed	absent	0
	present	2
uncontrolled hypertension	absent	0
	present	1
anemia	absent	0
	present	1
genetic factors	absent	0
	present	1
excessive fall risk	absent	0
	present	1
stroke	absent	0
	present	1

where:

• Therapy with antiplatelet drugs would be associated with reduced platelet function.

total score =

= SUM(points for all 11 parameters)

Interpretation:

• minimum score: 0

• maximum score 12

• The higher the score the greater the risk of hemorrhage.

Total Score	Rate of Bleeding per 100 Patient Years of Warfarin
0	1.9
1	2.5
2	3
3	8.4
4	10.4
>= 5	12.3

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Description

Specialty

Objective

ICD-10

HEMORR2HAGES Score of Gage et al for Predicting Hemorrhage in a Patient with Atrial Fibrillation

Purpose: To identify an older adult receiving antithrombotic therapy for atrial fibrillation who is at increased risk for bleeding using HEMORR2HAGES.

Description

Specialty

Objective

ICD-10