Circulation: New tool calculates risk of bleeding in MI patients

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With eight basic medical facts in hand, doctors can now estimate the risk of bleeding for a patient having a heart attack and help lessen the chances of occurrence, according to a study published in the April 14 issue of Circulation.

"Until now, there hasn't been a simple tool applicable to the general population that can predict the risk of bleeding before patients are treated for heart attack," said study author, Richard G. Bach, MD, a Washington University cardiologist and medical director of the cardiac intensive care unit at Barnes-Jewish Hospital, both in St. Louis. "Older methods for estimating risk either were derived from a low-bleeding-risk population or used variables that aren't available until after treatment is begun."

The research was led by Sumeet Subherwal, MD, formerly a Barnes-Jewish Hospital medical resident at Washington University Medical Center and now a cardiology fellow at Duke University in Durham, N.C., in collaboration with several investigators including Karen Alexander, MD, a cardiologist at the Duke Clinical Research Institute.

The investigators analyzed the medical histories of more than 89,000 patients hospitalized in the U.S. for non-STEMI.

The patient histories were part of the Crusade Quality Improvement Initiative, a national multicenter program that aims to improve outcomes for heart attack patients. The risk assessment tool is called the Crusade bleeding score.

"A lot of treatment decisions have to be made very promptly after the patient arrives," says Bach, also associate professor of medicine in the cardiovascular division at Washington University School of Medicine. "We designed a bleeding-risk stratification tool that would require only those variables that can be obtained up front. It's a practical tool that can be used in any hospital setting."

The Crusade bleeding score identified eight factors that could predict the odds that a heart attack patient might suffer a bleeding event. The factors are gender, heart rate, blood pressure, hematocrit, creatinine clearance, diabetes, peripheral vascular disease or stroke and congestive heart failure.

The bleeding score calculation assigns points to each factor so that the total score coincides with risk of bleeding evidenced in the Crusade cases. The range of possible scores is divided into five categories from very low to very high risk of bleeding.

The bleeding risk score is intended to help guide critical early treatment decisions for clinicians caring for heart attack patients, but the impact of its use on outcomes will need to be tested in clinical trials, Bach said. Potentially, the score will be used in conjunction with other practice guidelines to optimize heart attack treatment and minimize risk.