Antithrombotic Therapy in Acute Coronary Syndrome Medical Algorithm

Description

Mehran et al developed a score for predicting the risk of major bleeding in a patient receiving antithrombotic therapy for the acute coronary syndrome (ACS). The authors are from Columbia University, London School of Hygiene and Tropical Medicine, Hospital Corporation of America, New York University, Duke University, Benjamin Franklin University Medicine Berlin, and Ospedali Riuniti de Bergamo.

Patient selection: acute coronary syndrome treated with either heparin plus a glycoprotein IIb/IIIa inhibitor or bivalirudin

Major bleeding included:

(1) intracranial or intraocular bleeding

(2) access site hemorrhage requiring intervention

(3) drop in hemoglobin >= 4 g/dL without an overt bleeding site

(4) drop in hemoglobin >= 3 g/dL with an overt bleeding site

(5) reoperation for bleeding

(6) need for blood product transfusion

Parameters:

(1) gender

(2) age in years

(3) serum creatinine in mg/dL

(4) white blood cell count per µL

(5) anemia

(6) presentation

(7) antithrombotic medication

Parameter	Finding	Points
gender	male	0
	female	8
age in years	< 50 years	0
	50 to 59 years	3
	60 to 69 years	6
	70 to 79 years	9
	>= 80 years of age	12
serum creatinine	< 1.0 mg/dL	0
	1.0 to 1.19 mg/dL	2
	1.2 to 1.39 mg/dL	3
	1.4 to 1.59 mg/dL	5
	1.6 to 1.79 mg/dL	6
	1.80 to 1.99 mg/dL	8
	>= 2.0 mg/dL	10
WBC count	< 10,000 per µL	0
	10,000 to 11,999 per µL	2
	12,000 to 13,999 per µL	3
	14,000 to 15,999 per µL	4
	16,000 to 17,999 per µL	6
	18,000 to 19,999 per µL	8
	>= 20,000 per µL	10
anemia	no	0
	yes	6
presentation	STEMI	6
	NSTEMI with raised biomarkers	2
	NSTEMI with normal biomarkers	0
antithrombotic medication	bivalirudin monotherapy	-5
	heparin plus GPI	0

total score =

= SUM(points for all 7 parameters)

Interpretation:

• minimum score: -5

• maximum score: 42

• The higher the score the greater the risk of major bleeding.

Total Score	Risk for Major Bleeding within 30 Days
< 10	low (<= 2.8%)
10 to 14	moderate
15 to 19	high
>= 20	very high (>= 8.0%)

If the data in Figure 2 is analyzed:

Total Score	Risk of Major Bleeding
0 to 20	(0.01629 * ((score)^2)) + (0.01629 * (score)) + 0.9743
20 to 42	(0.05257 * ((score)^2)) - (1.374 * (score)) + 14.37

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Description

Specialty

Objective

ICD-10

Risk Score for Bleeding in Patient Receiving Antithrombotic Therapy for Acute Coronary Syndrome (ACS)

Purpose: To predict the risk of major bleeding in a patient receiving antithrombotic therapy for acute coronary syndrome (ACS) using the score of Mehran et al.

Description

Specialty

Objective

ICD-10