Hilkens et al reported the S2TOP-BLEED score to predict the risk of bleeding for a patient taking antiplatelet drugs for noncardioembolic stroke prevention. The authors are from multiple institutions in Europe and the United States.
S2TOP-BLEED is an acronym for the score components.
Patient selection: history of TIA or ischemic stroke, receiving antiplatelet therapy, age > 45 years
Outcome: 3-year risk of major bleed
Parameters:
(1) sex (S)
(2) current smoking (S)
(3) type of antiplatelet therapy (T)
(4) outcome on modified Rankin scale (O
(5) prior stroke (P)
(6) hypertension (B for blood pressure)
(7) body mass index (L for Low BMI)
(8) age in years (E for elderly)
(9) Asian race (E for ethnicity)
(10) diabetes (D)
|
Parameter |
Finding |
Points |
|
sex |
female |
0 |
|
|
male |
2 |
|
current smoker |
no |
0 |
|
|
yes |
1 |
|
antiplatelet drug |
clopidogrel monotherapy |
0 |
|
|
aspirin with or without dipyridamole |
1 |
|
|
aspirin plus clopidogrel |
5 |
|
modified Rankin scale |
0 to 2 |
0 |
|
|
3 to 5 |
2 |
|
prior stroke |
no (TIA) |
0 |
|
|
yes |
1 |
|
hypertension |
no |
0 |
|
|
yes |
1 |
|
BMI |
< 20 |
2 |
|
|
20 to 25 |
1 |
|
|
> 25 |
0 |
|
age |
45 to 54 |
2 |
|
|
55 to 64 |
4 |
|
|
65 to 74 |
6 |
|
|
75 to 84 |
9 |
|
|
>= 85 |
12 |
|
Asian |
no |
0 |
|
|
Asian |
1 |
|
diabetes |
no |
0 |
|
|
yes |
1 |
total score with age =
= SUM(points for all 10 parameters)
total score without age =
= SUM(points for other 9 parameters)
Interpretation:
• minimum score without age: 0
• minimum score with age: 2
• maximum score without age: 16
• maximum score with age: 28
• The higher the score the greater the risk of bleeding.
|
3-Year Risk |
45-54 |
55-64 |
65-74 |
75-84 |
>=85 |
|
2 |
0 to 4 |
0 to 2 |
0 |
|
|
|
3 |
5 or 6 |
3 or 4 |
1 or 2 |
|
|
|
4 |
7 or 8 |
5 or 6 |
3 or 4 |
0 or 1 |
|
|
5 |
9 |
7 |
5 |
2 |
|
|
6 |
10 or 11 |
8 or 9 |
6 or 7 |
3 or 4 |
1 |
|
7 |
12 |
10 |
8 |
5 |
2 |
|
8 |
13 |
11 |
9 |
6 |
3 |
|
9 |
|
|
|
|
|
|
10 |
|
12 |
10 |
7 |
4 |
|
11 |
|
13 |
11 |
8 |
5 |
|
12 |
|
|
|
|
|
|
13 |
|
|
12 |
9 |
6 |
|
14 |
|
|
13 |
10 |
7 |
|
15 |
|
|
|
|
|
|
16 |
|
|
|
|
|
|
17 |
|
|
|
11 |
8 |
|
18 |
|
|
|
12 |
9 |
|
19 |
|
|
|
|
|
|
>20 |
|
|
|
13 |
10 to 13 |
Performance:
• The area under the ROC curve is 0.63.
Specialty: Hematology Oncology
