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HEMORR2HAGES Bleeding Risk Score
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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Clinical feature /   Points

H Hepatic or renal disease (Points: 1 )
E Ethanol abuse (Points: 1 )
M Malignancy  (Points: 1 )
O Older age (>75)  (Points: 1 )
R Reduced platelet count or function  (Points: 1 )
R Rebleeding risk (ie: prior bleed) (Points: 2)
H Hypertension (uncontrolled)  (Points: 1 )
   
A Anemia  (Points: 1 )
G Genetic factors (CYP2C9 variant)  (Points: 1 )
   
E  Excessive fall risk  (Points: 1) 
S Stroke    (Points: 1) 

Background



Risk Score Incidence of Major Bleeding (Bleeds per 100 patient-yrs (95% CI) )
0 1.9 (0.6-4.4)
1 2.5 (1.3-4.3)
2 5.3 (3.4-8.1)
3 8.4 (4.9-13.6)
4 10.4 (5.1-18.9)
>=5 12.3 (5.8-23.1)


References:
[1 ] Gage BF, Yan Y Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillatiion. Am Heart J 2006; 151:713-9.

"In summary, the decision to take antithrombotic therapy should be based on individual risks and benefits. For example, by combining HEMORR2HAGES with a clinical prediction rule for stroke, clinicians can trade off the risks and benefits of prescribing anticoagulant versus antiplatelet therapy in elderly patients with atrial fibrillation. Patients with a high risk of bleeding could avoid anticoagulants unless their risks of stroke were high enough to justify the risks, in which case they could take anticoagulants with vigilant monitoring."

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Disclaimer

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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