Kearon et al identified risk factors for bleeding in a patient being treated with warfarin. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Canada and the United States.
Patient selection: warfarin therapy to prevent recurrent venous thromboembolism
Outcome: clinically significant bleeding
Parameters:
(1) age in years
(2) history of stroke
(3) history of peptic ulcer disease
(4) history of gastrointestinal (GI) bleeding
(5) serum creatinine in mg/dL
(6) anemia or thrombocytopenia
(7) liver disease
(8) diabetes mellitus
(9) antiplatelet therapy
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
>= 65 years |
1 |
|
history of stroke |
no |
0 |
|
|
yes |
1 |
|
history of peptic ulcer |
no |
0 |
|
|
yes |
1 |
|
history of GI bleed |
no |
0 |
|
|
yes |
1 |
|
serum creatinine |
<= 1.5 mg/dL |
0 |
|
|
> 1.5 mg/dL |
1 |
|
anemia or thrombocytopenia |
absent |
0 |
|
|
present |
1 |
|
liver disease |
absent |
0 |
|
|
present |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
antiplatelet therapy |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 9
• The risk for bleeding increases with the number of risk factors.
|
Score |
Risk Category (Fang et al) |
|
0 or 1 |
low |
|
2 |
intermediate |
|
3 |
high |
|
4 to 9 |
very high |
Specialty: Hematology Oncology, Clinical Laboratory, Pharmacology, clinical
