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A Practical Guide to Haemostasis


Assessing the Risk of Bleeding in Patients with non-valvular Atrial Fibrillation [AF]:
The HEMORR2HAGES Score

Introduction

The HEMORR2HAGES algorithm is a risk assessment model designed to quantify the risk of haemorrhage in patients with Atrial Fibrillation over the age of 75 years. The algorithm consists of 11 criteria and which are summarised below:


The HEMORR2HAGES Score:



Select Criteria:

[H]
Hepatic or Renal Disease
1 Point
[E]
Ethanol Abuse
1 Point
[M]
Malignancy
1 Point
[O] 
Older Age [ ≥ 75 years]
1 Point
[R]
Reduced Platelet Count or Function
1 Point
[R]
Re-bleeding [Previous Bleed]
2 Points
[H]
Hypertension [Uncontrolled]
1 Point
[A]
Anaemia
1 Point
[G]
Genetic Risk Factors [CYP 2C9 snp]
1 Point
[E]
Excessive fall risk
1 Point
[S]
Stroke
1 Point

Score
[Max Score 12]


Interpretation
Score Number of Major Bleeds per 100-patient years of Warfarin [%]
0 1.9
1 2.5
2 5.3
3 8.4
4 10.4
≥5 12.3




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