HEMORR2HAGES score for major bleeding risk
HEMORR2HAGES is an acronym for risk assessment in elderly patients with atrial fibrillation requiring anti-coagulation.
Research authors: Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ.
Details Formula Study characteristics Files & References
Model author
Model ID
354
Version
1.12
Revision date
2016-04-25
Specialty
MeSH terms
  • Elderly
  • Anticoagulant Drugs
  • Atrial Fibrillation
  • Bleeding
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    The NRAF data set included 3932 Medicare beneficiaries with chart-confirmed atrial fibrillation. After excluding records with missing information (n = 141), we analyzed the remaining 3791 patients. Mean age was 80.2 years, and 57% of the cohort was women. During 3138 patient-years of follow-up, there were 162 admissions with a bleed (5.2 bleeds per 100 patient-years).
    Two thirds (67.3%) of these bleeds were gastrointestinal hemorrhages, 15.4% were intracranial, and 17.3% were in other locations. The 30-day mortality of patients admitted with a bleed (in any location) was 21.6%.

    One thousand six hundred four (1604) patients were discharged on warfarin (113 of whom also received aspirin), 660 patients were discharged on aspirin (or a thienopyridine) alone, and 1527 were prescribed no antithrombotic therapy on discharge.

    Study Population

    Total population size: 3791
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    HEMORR2HAGES score warfarin group 1.9 points
    HEMORR2HAGES score asparin group 3.1 points
    HEMORR2HAGES score neither warfarin or asparin group 2.1 points

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Bleeding risk factors in warfarin group (n=1604) Hepatic or renal disease 127
    Ethanol use 12
    Malignancy 77
    Older age (>75 years) 1110
    Reduced platelet count or function 154
    Rebleeding risk 255
    Hypertension (uncontrolled) 7
    Anemia 137
    Genetic factors NA
    Excessive fall risk or neuropsychiatric disease 597
    Stroke 31
    Bleeding risk factors in aspirin group (n=660) Hepatic or renal disease 80
    Ethanol abuse 4
    Malignancy 22
    Older age (>75 years) 518
    Reduced platelet count or function 660
    Rebleeding risk 142
    Hypertension (uncontrolled) 4
    Anemia 70
    Genetic factors NA
    Excessive fall risk or neuropsychiatric disease 183
    Stroke 198
    Bleeding risk factors in group with neither warfarin or aspirin (n=1527) Hepatic or renal disease 184
    Ethanol abuse 14
    Malignancy 138
    Older age (>75 years) 1170
    Reduced platelet count or function 80
    Rebleeding risk 338
    Hypertension (uncontrolled) 10
    Anemia 226
    Genetic factors NA
    Excessive fall risk or neuropsychiatric disease 368
    Stroke 32

    HEMORRHAGES score:
    ...
    points

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    Result
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    HEMORRHAGES score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    The HEMORR2HAGES score can be applied to stratify the risk for bleeding after anti-coagulation for atrial fibrillation in conjunction with situation specific risks/benefits.

    {{ file.classification }}

    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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