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Risk Score of Landefeld and Goldman for Warfarin-Associated Major Bleeding in Outpatients

Purpose: To predict the risk of major bleeding in an outpatient treated with warfarin using the risk score of Landefeld and Goldman.

Description

Landefeld and Goldman developed a risk score that could predict the risk of a major bleeding episode in outpatients treated with warfarin. The score uses information available when the oral anticoagulant therapy is begun. The authors are from Case Western Reserve University in Cleveland and Harvard Medical School in Boston.


Parameters:

(1) age of the patient

(2) history of stroke

(3) history of gastrointestinal bleeding

(4) comorbid conditions

(5) atrial fibrillation

 

Parameter

Finding

Points

age of the patient

< 65 years

0

 

>= 65 years

1

history of stroke

none

0

 

either current or past

1

 

both current and past

2

history of gastrointestinal bleeding

none

0

 

present

1

serious comorbid condition

none

0

 

present

1

atrial fibrillation

none

0

 

present

1

 

where:

• Serious comorbid conditions included renal insufficiency, recent myocardial infarction, and severe anemia

 

risk score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 6

 

 

 

Cumulative Incidence of Major Bleeding

Score

Risk Group

at 12 Months

at 48 Months

0

low

2%

2%

1 or 2

moderate

11%

17%

3, 4, 5 or 6

high

16%

63%

from page 149, Landefeld (1989)


 


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Specialty

Objective

ICD-10