Biancari et al reported the WILL-BLEED score for predicting severe bleeding after cardiac surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from Oulu University in Finland.
Patient selection: cardiac surgery
Outcome: severe bleeding
Parameters:
(1) preoperative anemia
(2) sex
(3) eGFR in mL per min per 1.73 square meter
(4) number of days potent antiplatelet drugs stopped prior to surgery
(5) critical preoperative state
(6) acute coronary syndrome (ACS)
(7) use of LMW-heparin, fondaparinux or unfractionated heparin
Parameter
Finding
Points
preoperative anemia
no
0
yes
3
sex
male
0
female
2
eGFR
>= 45
0
< 45
3
number of days that potent antiplatelet drugs stopped
< 5 days
2
>= 5 days
0
critical preoperative state
no
0
yes
5
acute coronary syndrome
no
0
yes
2
use of LMW heparin, fondaparinux or unfractionated heparin
no
0
yes
1
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the greater the risk of severe bleeding.
Score
Percent Severe Bleeding
0 to 3
2.9-3.4%
4 to 6
6.6-7.5%
>= 7
24%
Performance:
• The area under the ROC curve was 0.73.
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