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A Practical Guide to Haemostasis


Venous Thromboembolic Disease [VTED] & Bleeding

Introduction

Anticoagulation is potentially associated with an increased risk of bleeding and all patients who are about to commence anticoagulation should undergo a bleeding risk assessment,  A number of Risk Assessment Scoring systems have been developed to assist with this and the commonly used algorithms are summarised below with links to the relevant algorithms.


The RIETE Score


The RIETE [Registro Informatizado de Enfermedad Tromboembolica] score was designed to predict the risk of major bleeding in patients with acute venous thromboembolic disease [VTED] within three months of commencing anticoagulant therapy with Warfarin.

Click HERE to access The RIETE Score.


The VTE-BLEED Score


The VTE-BLEED score was developed to identify patients on anticoagulation for VTED and who were at increased risk of bleeding.  The original study was based on an analysis of patients enrolled in various trials evaluating Dabigatran [a direct Thrombin inhibitor] versus standard treatment with Warfarin but subsequent studies have evaluated patients on Rivaroxaban [a direct Factor Xa inhibitor].

Click HERE to access The VTE-BLEED Score.

The IMPROVE Bleed Risk Assessment Model [RAM]


VTED is a major cause of death in hospitalised patients and this can be reduced with thromboprophylaxis.  The IMPROVE Bleed RAM was designed to estimate the risk of bleeding in acutely ill hospitalised patients and from this who might benefit from thromboprophylaxis.

Click HERE to access the IMPROVE Bleed Risk Assessment Model.

The SAMe-TT2R2 score


The SAMe-TT2R2 score was originally devised as a system for identifying individuals with Atrial Fibrillation in whom poor anticoagulation control was likely to be a problem.  It was subsequently evaluated in patients with acute VTE to establish whether individuals with a SAMe-TT2R2 score that would predict poor anticoagulant control with a Vitamin K antagonist e.g. Warfarin would  be more effectively treated with a DOAC.

Click HERE to access the SAMe-TT2R2 algorithm.