ToolsCalculators
VTE-BLEED Score
Estimates the risk of major bleeding during stable (extended) anticoagulation after venous thromboembolism.
VTE-BLEED Score
Active cancer
Male with uncontrolled hypertension (systolic BP ≥140 mmHg)
Only applies to male patients; scores 0 in women regardless of blood pressure.
Anaemia (Hb <13 g/dL in men, <12 g/dL in women)
History of major or clinically relevant non-major bleeding
Age ≥60 years
Renal dysfunction (creatinine clearance/eGFR <60 mL/min)
Result0 points
Low risk of major bleeding during stable anticoagulation (derivation cohort incidence approximately 2.8%).
- Risk category
- Low (<2 points)
- Expected major bleeding incidence
- ~2.8%
When to use
- Estimating major bleeding risk to help decide on extending anticoagulation beyond the initial 3–6 months after a first VTE.
- Weighing bleeding risk against recurrence risk once the acute (first 30 days) treatment phase has passed.
Formula
Sum of: active cancer (2 points), male with uncontrolled hypertension i.e. systolic BP ≥140 mmHg (1 point), anaemia i.e. Hb <13 g/dL men or <12 g/dL women (1.5 points), history of major or clinically relevant non-major bleeding (1.5 points), age ≥60 years (1.5 points), renal dysfunction i.e. creatinine clearance/eGFR <60 mL/min (1.5 points). Range 0–9; a threshold of 2 points optimally separates low- from high-risk patients.
Pearls and pitfalls
- Derived and validated for patients on stable anticoagulation after the first 30 days of treatment following acute VTE, not for the early/acute treatment phase.
- Derived from the dabigatran arms of the pooled RE-COVER trials using logistic regression; 'male with uncontrolled hypertension' is the only time-varying component.
- None of its variables overlap with VTE-recurrence prediction scores, which avoids the ambiguity of trading off two scores that share predictors.