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HEMORR2HAGES Bleeding Risk Score

HEMORR2HAGES risk score was created to evaluate individual bleeding risk in atrial fibrillation (AF). Assessing bleeding risk is necessary to determine if anticoagulation therapy should be considered in patients with atrial fibrillation and the perceived benefit of therapy is greater than the risk of bleeding.
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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) 


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)

[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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