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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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Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com, assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

1. CYP 2C9: CYP 2C9 is a cytochrome P450 enzyme involved in the oxidation for various compounds. A number of polymorphisms [snps] for this enzyme have been reported and these can affect the metabolism of a number of drugs including Warfarin.

LINKS & References

1. Gage BF, Yan Y, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). American heart journal. 2006; 151: 713-9.

2. Apostolakis S, Lane DA, et al. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. Journal of the American College of Cardiology. 2012; 60: 861-7.

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Updated:         27-Sep-2022