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ATRIA Bleeding Risk Score

Estimates major hemorrhage risk on warfarin in patients with atrial fibrillation.

ATRIA Bleeding Risk Score
Anemia (hemoglobin <13 g/dL men, <12 g/dL women)
Severe renal disease (eGFR <30 mL/min or dialysis-dependent)
Age >=75 years
Prior hemorrhage
Diagnosed hypertension
Result0 points

Approximate major hemorrhage rate of 0.8% per year on warfarin.

Annual major hemorrhage rate
0.8%

When to use

  • Weighing bleeding risk against stroke-prevention benefit before starting or continuing anticoagulation in atrial fibrillation.

Formula

Points: anemia 3, severe renal disease 3, age >=75 years 2, prior hemorrhage 1, hypertension 1. Score 0-3 = low risk, 4 = intermediate, 5-10 = high risk.

Pearls and pitfalls

  • Derived in a warfarin-treated AF cohort; applicability to direct oral anticoagulants is less well validated.

References

  1. Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA Study. J Am Coll Cardiol. 2011;58(4):395-401.