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Risk Score of Landefeld et al for Anticoagulant-related Major Bleeding in Hospitalized Patients

Purpose: To predict the risk for anticoagulant-related major bleeding in hospitalized patients by looking at four risk factors.

Description

The presence of independent risk factors is associated with anticoagulant-related major bleeding in hospitalized patients starting long-term anticoagulant therapy.


Risk Factor

Finding

Points

number of comorbid conditions present at start of anticoagulation therapy

0

0

 

1

1

 

2

2

 

3 or 4

3

intravenous heparin in older patients

< 60 years

0

 

age 60 - 79 years

2

 

age >= 80 years

4

maximal prothrombin time or activated partial thromboplastin time ratio

< 2.0

0

 

2.0 - 2.9

1

 

>= 3.0

2

worsening liver function during therapy

no

0

 

yes

2

 

 

Comorbid Conditions

Includes

serious cardiac disease

acute myocardial infarction

 

hypotension (systolic blood pressure < 90 mm Hg) at admission

 

hypotension after admission requiring an intra-aortic balloon pump

liver dysfunction

hyperbilirubinemia

 

macrocytosis

renal insufficiency

creatinine > 1.47 mg/dL

poor general condition

cancer

 

hematocrit < 0.30

 

where:

• total bilirubin: conversion factor from mg/dL to µmol/L: 17.1

• upper limit of reference range:

1 week - 60 years: 1.2 mg/dL

60 - 90 years: 1.1 mg/dL

> 90 years: 0.9 mg/dL

• creatinine: conversion factor from mg/dL to µmol/L:  88.4

• worsening liver function is present if:

(1) hyperbilirubinemia present at start of therapy, and

(2) total serum bilirubin rises to a value >= 4 mg/dL, and

(3) no evidence of a nonhepatic cause to explain bilirubin rise

• worsening liver function was given 4 points in Landefeld (1987) but the 2 points in Landefeld (1990) and Landefeld (1992)

 

point score =

= (points for comorbid conditions) + (points for heparin in older patients) + (points for PT or aPTT ratio) + (points for worsening liver function)

 

Interpretation:

• minimum score 0

• maximum score 11

 

Score

Risk

0 –2

low

3 – 4

moderate

5 – 11

high risk

 

Limitations:

• Wester et al found that the Landefeld score was not effective in a group of mostly medical patients being treated for acute thromboembolism with heparin or low molecular heparin. They developed the Utrecht bleeding risk score based on the risk factors they identified.

• The score is not useful to identify patients at risk of minor bleeding.


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Specialty

Objective

ICD-10