Fang et al developed a simple score for identify a patient at risk for bleeding associated with warfarin therapy. This can help identify a patient who may benefit from more aggressive management. The authors are from UCSF, Kaiser Permanente of North California, and Massachusetts General Hospital.
Patient selection: warfarin therapy for atrial fibrillation
Outcome: warfarin-associated hemorrhage
Parameters:
(1) anemia (male with hemoglobin < 13 g/dL; female with hemoglobin < 12 g/dL)
(2) severe renal disease (estimated GFR < 30 mL per min, or dialysis dependent)
(3) age in years
(4) any history of a previous hemorrhage
(5) diagnosed with hypertension
|
Parameter |
Finding |
Points |
|
anemia |
absent |
0 |
|
|
present |
3 |
|
severe renal disease |
absent |
0 |
|
|
present |
3 |
|
age in years |
< 75 years |
0 |
|
|
>= 75 years |
2 |
|
history of hemorrhage |
no |
0 |
|
|
yes |
1 |
|
hypertension |
absent |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of bleeding.
|
Score |
Bleeding Events per 100 Person Years |
|
0 to 3 |
<= 1 |
|
4 |
2.6 |
|
5 to 7 |
5 to 6 |
|
8 |
10 |
|
9 |
12 |
|
10 |
17 |
|
Score |
Risk Category |
|
0 to 3 |
low |
|
4 |
intermediate |
|
5 to10 |
high |
Performance:
• The area under the ROC curve was 0.76 for the continuous risk score.
Specialty: Hematology Oncology, Clinical Laboratory, Pharmacology, clinical
