The presence of independent risk factors is associated with anticoagulant-related major bleeding in hospitalized patients starting long-term anticoagulant therapy.
number of comorbid conditions present at start of anticoagulation therapy
3 or 4
intravenous heparin in older patients
< 60 years
age 60 - 79 years
age >= 80 years
maximal prothrombin time or activated partial thromboplastin time ratio
2.0 - 2.9
worsening liver function during therapy
serious cardiac disease
acute myocardial infarction
hypotension (systolic blood pressure < 90 mm Hg) at admission
hypotension after admission requiring an intra-aortic balloon pump
creatinine > 1.47 mg/dL
poor general condition
hematocrit < 0.30
• 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)
• minimum score 0
• maximum score 11
3 – 4
5 – 11
• 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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Purpose: To predict the risk for anticoagulant-related major bleeding in hospitalized patients by looking at four risk factors.
Specialty: Hematology Oncology, Clinical Laboratory, Pharmacology, clinical
Objective: risk factors, severity, prognosis, stage
ICD-10: O22, O87,