HEMORR₂HAGES Bleeding Risk Score

HEMORR₂HAGES Bleeding Risk Score

The HEMORR₂HAGES bleeding risk score is a clinical tool developed to assess the risk of major bleeding in patients with atrial fibrillation (AF) on anticoagulation therapy. Its purpose is to guide clinicians in balancing estimating the risks of bleeding.

Components of the HEMORR₂HAGES Score

The acronym HEMORR₂HAGES represents the following parameters:

  • Hepatic or renal disease (1 point)
  • Ethanol abuse (1 point)
  • Malignancy (1 point)
  • Older age (>75 years) (1 point)
  • Reduced platelet count or function (1 point)
  • Re-bleeding risk, i.e., prior bleeding (2 points)
  • Hypertension, uncontrolled (1 point)
  • Anemia (1 point)
  • Genetic factors (e.g., CYP2C9 variants) (1 point)
  • Excessive fall risk (1 point)
  • Stroke (1 point)
HEMORR₂HAGES ScoreRisk categoryIncidence of major bleeding (per 100 patient-years)
0Low1.9
1Low2.5
2Intermediate5.3
3Intermediate8.4
4High10.4
≥5High12.3
Interpretation of HEMORR₂HAGES score.

Comparison with ATRIA and HAS-BLED Scores

Several studies have compared the predictive performance of HEMORR₂HAGES with other bleeding risk assessment tools, notably ATRIA and HAS-BLED:

  • HAS-BLED Score: In a study evaluating bleeding risk prediction in AF patients, the HAS-BLED score demonstrated superior predictive performance compared to both HEMORR₂HAGES and ATRIA. The HAS-BLED score had the highest net reclassification improvement for predicting clinically relevant bleeding, with a 10.3% and 13% improvement compared with HEMORR₂HAGES and ATRIA, respectively (Apostolakis et al).
  • ATRIA Score: The same study found that the ATRIA score had a lower predictive performance for major bleeding compared to HAS-BLED. The C-indices were 0.60 for HAS-BLED, 0.55 for HEMORR₂HAGES, and 0.50 for ATRIA, indicating that HAS-BLED had better discrimination ability (Apostolakis et al).

Overall, the HAS-BLED score may offer better predictive accuracy for bleeding risk in AF patients undergoing anticoagulation therapy.

References

1. Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation. Am Heart J. 2006;151(3):713-719.

2. Apostolakis S, Lane DA, Guo Y, Buller H, Lip GY. Performance of the HEMORR₂HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS study. J Am Coll Cardiol. 2012;60(9):861-867.

3. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-1100.

Updated on 2025-01-18