HEMORR₂HAGES Score for Major Bleeding Risk

id

1785

full_title

HEMORR₂HAGES Score for Major Bleeding Risk

short_title

HEMORR₂HAGES Score

med_description

Quantifies risk of hemorrhage in elderly patients with AFib.

description

The HEMORR2HAGES Score quantifies the bleeding risk for elderly patients with atrial fibrillation who are anticoagulated with coumadin/warfarin.

keywords

Hemorrhage risk, hemorrhage risk calculator, hemorrhage elderly, hemorrhage elderly risk, hemorrhage afib risk, elderly afib risk, hemorr2, hemorr2hages, bleed risk elderly, bleed risk elderly score, hemorrhages atrial fibrillation risk, hemorr2hages risk calculator

complaint

[ "Bleeding" ]

formula

Addition of the selected points, see below:

evidence

One meta analysis (see references, below) specifically recommends using the HAS-BLED Score over the HEMORR₂HAGES Score because of the former's greater sensitivity (the latter, however, did have better specificity).

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/16504638", "text": "Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation. Am Heart J 2006; 151:713-9." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25012972", "text": "Caldeira D, Costa J, Fernandes RM, Pinto FJ, Ferreira JJ. Performance of the HAS-BLED high bleeding-risk category, compared to ATRIA and HEMORR2HAGES in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2014;40(3):277-284." } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/22858389/", "text": "Apostolakis S, Lane DA, Guo Y, Buller H, Lip GYH. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (Evaluating the use of sr34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. J Am Coll Cardiol. 2012;60(9):861-867." } ], "Validations": [] }

pearls

The HEMORR₂HAGES score was developed to quantify the risk of hemorrhage in patients with atrial fibrillation on anticoagulation and to aid in the management of antithrombotic therapy.

• Combined hemorrhage risk factors from three previously existing clinical prediction rules to form the HEMORR₂HAGES mnemonic.
• Validated the score by retrospectively applying it to a cohort of patients from the National Registry of Atrial Fibrillation database.
• Scoring system consists of eleven criteria, one of which (history of prior bleeding) is worth 2 points, while the other ten are worth 1 point each.
• For the basis of comparison to other bleeding risk schemes, patients with a score of 0 or 1 were classified as low-risk, 2 or 3 intermediate-risk, ≥4 high-risk.
• Study found that the number of bleeds per 100 patient-years of warfarin increased as their HEMORR₂HAGES score increased.
• For patients on warfarin, study found that HEMORR₂HAGES was more discriminatory compared to the other schemes.

Points to keep in mind:

• Degree of hemorrhage was not examined in the study; all study patients with ICD-9 codes for active hemorrhage in any location were included.
• The genetic risk factor was included in their score, but not actually tested in their cohort of patients.
• There were variable definitions of hepatic or renal disease, thrombocytopenia depending on the state in which the patient lived.
• All data was obtained retrospectively, via chart review and ICD-9 codes. Events occurring outside of the hospital or coded incorrectly were not included.
• Anemia, malignancy and uncontrolled hypertension were included in a patient’s score if they were entered in as ICD-9 diagnoses, regardless if they were clinically important or not (e.g. distant history of cancer which has been in complete remission would still count as malignancy by ICD-9).
• Excessive fall risk was determine by chart review for “high risk of falling, dementia, Parkinson's disease, or psychiatric disease.”
• Study also examined ASA usage, but does not present specific data on the risk of hemorrhage on ASA with different HEMORR₂HAGES scores.
• There was no comparison to more recently derived bleeding risk scores such as ATRIA or HAS-BLED.

A subsequent systemic review and meta-analysis comparing the performance of HAS-BLED, ATRIA and HEMORR₂HAGES recommended HAS-BLED for the assessment of atrial fibrillation patients’ major bleeding risk. The analysis found that HEMORR₂HAGES had a higher diagnostic accuracy, but considered it difficult to use due to its complexity.

usecase

Consider using the HEMORR₂HAGES score to stratify patients’ risk for bleeding after anticoagulation for atrial fibrillation in conjunction with situation specific risks/benefits.

reasons

Combines components from several other previously validated bleeding risk scores into one.

next_advice

next_actions

• Risks and benefits of anticoagulation should be carefully considered in ALL patients prior to initiating therapy.
• Other risk stratification scores such as HAS-BLED or ATRIA should also be taken into consideration prior to starting anticoagulation.
• Alternative options should often be considered in patients with high-risk of major bleeding events in need of anticoagulation.

next_management

diseases

[ "Atrial Fibrillation", "Bleeding/Hemorrhage", "Intracranial Hemorrhage", "Stroke/TIA", "Subarachnoid Hemorrhage" ]

instructions

The HEMORR₂HAGES Score was developed using ICD-9 data; while we are actively reaching out to its study authors, the terms included in the score are not defined in the study.

published

2022-04-21T20:29:01.076Z

purpose

[ "Prognosis", "Treatment" ]

search_terms

[ "hemorr2hages", "bleeding", "coumadin", "warfarin", "afib", "stroke risk" ]

seo

{ "keywords_en": "Hemorrhage risk, hemorrhage risk calculator, hemorrhage elderly, hemorrhage elderly risk, hemorrhage afib risk, elderly afib risk, hemorr2, hemorr2hages, bleed risk elderly, bleed risk elderly score, hemorrhages atrial fibrillation risk, hemorr2hages risk calculator", "meta_description_en": "The HEMORR2HAGES Score quantifies the bleeding risk for elderly patients with atrial fibrillation who are anticoagulated with coumadin/warfarin." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Family Practice", "Geriatrics", "Hematology and Oncology", "Hospitalist Medicine", "Internal Medicine" ]

departments

[ "Cardiac", "Hematologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1718, "short_title_en": "ATRIA Bleeding Risk", "slug": "atria-bleeding-risk-score" }, { "calcId": 807, "short_title_en": "HAS-BLED Score", "slug": "has-bled-score-major-bleeding-risk" }, { "calcId": 10504, "short_title_en": "GARFIELD-AF", "slug": "garfield-af" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "hematology" ]

cleaned_use

[ "Consider using the HEMORR₂HAGES score to stratify patients’ risk for bleeding after anticoagulation for atrial fibrillation in conjunction with situation specific risks/benefits." ]

pub

true