ABC-Bleeding Score for Anticoagulated Atrial Fibrillation
Biomarker-based bleeding risk score for patients with AF on oral anticoagulation. Outperforms HAS-BLED in some cohorts. Uses troponin, GDF-15, and haemoglobin alongside clinical variables.
Score interpretation
ABC-Bleeding low risk. Estimated annual major bleed rate < 2%.
→ Anticoagulation benefits outweigh risks in most AF patients. Continue OAC (DOAC preferred). Modifiable risk factors (BP, alcohol, NSAIDs) should still be addressed.
ABC-Bleeding moderate risk. Estimated annual major bleed rate 2-4%.
→ Reassess OAC choice. DOAC preferred over warfarin. Optimise modifiable bleeding risk factors. Shared decision-making with patient.
ABC-Bleeding high risk. Estimated annual major bleed rate > 4%.
→ Weigh bleeding vs stroke risk carefully. Revisit anticoagulation indication. Consider left atrial appendage occlusion if appropriate. Specialist cardiology/haematology review.
Interpretation bands for the ABC-Bleeding. Apply clinical judgement and local guidance.
References
- Hijazi Z, et al. The ABC (age, biomarkers, clinical history) bleeding risk score: a biomarker-based risk score for predicting bleeding in atrial fibrillation. Eur Heart J. 2016;37(20):1582-1590.
- Lip GYH, et al. Bleeding risk assessment and management in atrial fibrillation patients: executive summary of a position document from the European Heart Rhythm Association. Europace. 2019;21(4):531-535.
Related
Curated clinical cross-links plus same-class fallbacks.
- Bivalirudin (PCI Anticoagulation) · Direct Thrombin Inhibitor / PCI
- Vernakalant · Atrial-selective antiarrhythmic
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Bivalirudin · Anticoagulation
- Apixaban · Direct Oral Anticoagulant (DOAC) — Factor Xa Inhibitor
- Rivaroxaban · Direct oral anticoagulant (DOAC) — Factor Xa inhibitor
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The ABC-Bleeding is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.