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Assessing the Risk of Bleeding:
The IMPROVE Bleeding Risk Assessment Score

Introduction

The IMPROVE bleeding risk score was designed to estimate the risk of bleeding in acutely ill hospitalised patients in whom anticoagulation is being considered.

The IMPROVE Bleeding Risk Score:


Select Criteria:

Age
≥85 yrs 3.5 Points
40-84 yrs 1.5 Points
<40 yrs 0 Points
Gender
Male 1 Point
Female 0 Points
Renal Function
Normal Renal Function [GFR ≥60 ml/min/m2 0 Points
Moderate Renal Failure [GFR 30-59 ml/min/m2 1 Point
Severe Renal Failure [GFR <30 ml/min/m2 2.5 Points
Liver Function
Normal Liver Function [INR ≤ 1.5] 0 Points
Liver Failure [INR > 1.5] 2.5 Points
Platelet Count
≥50 x 109/L 0 Points
<50 x 109/L 4 Points
Admission to ICU or CCU
  2.5 Points
Central Venous Catheter
  2 Points
Active Gastric or Duodenal Ulcer
  4.5 Points
Prior Bleeding within previous 3 months
  4 Points
Rheumatic Disease
  2 Points
Active Malignancy
  2 Points

Score

[Max Score 30.5 Points]

Interpretation
Score Bleed Risk Category
<7 Not at increased risk of bleeding
≥7 Increased risk of bleeding


The American Society of Haematology [ASH 2024 - see References] has endorsed risk assessment models to individualise VTE prophylaxis in medical patients by balancing the risks associated with overuse - bleeding - and underuse - an increased risk of VTED. Incorporating the data from the IMPROVE VTE risk assessment model and the IMPROVE Bleeding risk assessment model, allowed the development of an integrated Fast-and-Frugal decision tree [FFT]. This is summarised below:

ASH 2024 FFT decision tree



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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.

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.

LINKS & References

1. Decousus H, Tapson VF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011; 139: 69-79.

2. Hostler DC, Marx ES, et al. Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score. Chest. 2016; 149: 372-9.

3. Rosenberg DJ, Press A, et al. External validation of the IMPROVE Bleeding Risk Assessment Model in medical patients. Thromb Haemost. 2016; 116: 530-6.

4. Schunemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018;2(22):3198-225

5. Djulbegovic B, Boylan A, Kolo S, et al. Converting IMPROVE bleeding and VTE risk assessment models into a fast-and-frugal decision tree for optimal hospital VTE prophylaxis. Blood Adv. 2024;8(12):3214-24.

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Updated:         16-Dec-2024