ARC HBR Major Minor Criteria Bleeding Risk Calculator

ARC HBR Major Minor Criteria Bleeding Risk Calculator Explanation and Clinical Context The Academic Research Consortium high bleeding risk construct was developed to provide a standardized binary definition of bleeding risk in patients undergoing percutaneous coronary intervention and receiving dual antiplatelet therapy. It organizes clinical characteristics into major and minor criteria that are based on expected one year incidence of serious bleeding events. Major criteria are conditions that alone are associated with a considerable rate of Bleeding Academic Research Consortium type three or type five bleeding such as chronic oral anticoagulant therapy severe chronic kidney disease very low hemoglobin recent major bleeding intracranial hemorrhage thrombocytopenia advanced liver disease active cancer and chronic bleeding diathesis.

Minor criteria include older age moderate renal dysfunction moderately low hemoglobin history of non recent major bleeding chronic treatment with oral non steroid anti inflammatory drugs or steroids and prior ischemic stroke without high risk features. In this calculator the number of major and minor criteria that are present in an individual patient is counted and the Academic Research Consortium definition is applied. A patient is classified as having high bleeding risk when at least one major criterion or at least two minor criteria are present.

This binary classification has been adopted in contemporary clinical research and incorporated into guideline discussions as one approach to define patients in whom the absolute risk of serious bleeding with intensive antithrombotic therapy is high. In the setting of acute coronary syndrome the identification of high bleeding risk can influence several management decisions including the selection of dual antiplatelet therapy regimen the possible choice of less potent P two Y twelve inhibitor in some scenarios the consideration of shortened dual antiplatelet therapy duration and the threshold for gastroprotective strategies and careful management of concomitant anticoagulation. The twenty twenty five American College of Cardiology and American Heart Association guideline for the management of patients with acute coronary syndromes emphasizes an individualized balance between ischemic and bleeding risks when planning antithrombotic therapy.

Academic Research Consortium high bleeding risk criteria are referenced as one pragmatic method to characterize bleeding risk particularly in patients who are candidates for percutaneous coronary intervention and dual antiplatelet therapy. For patients who meet high bleeding risk criteria guideline discussions support consideration of shorter dual antiplatelet therapy courses de escalation from more potent to less potent P two Y twelve inhibitors in appropriate clinical contexts and careful coordination when oral anticoagulation is also required. Clinicians should remember that the Academic Research Consortium definition is intentionally simple and binary and it does not replace clinical judgment or more granular bleeding risk scores.

Some patients who do not meet formal high bleeding risk criteria may still have important sources of bleeding vulnerability such as frailty recurrent falls or complex comorbidity that warrant individualized adjustment of antithrombotic therapy. Conversely some patients with high bleeding risk may remain at very high ischemic risk such that the benefit of prolonged or more potent antiplatelet therapy still outweighs bleeding concerns. This calculator is therefore best used as a structured aid to support bedside discussions shared decision making and documentation of bleeding risk assessment rather than as a stand alone directive tool.

Reference Urban P et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention. Circulation.

2019. Academic Research Consortium for High Bleeding Risk consensus document. Rao SV et al.

Twenty twenty five ACC AHA ACEP NAEMSP SCAI guideline for the management of patients with acute coronary syndromes. Circulation. Twenty twenty five.