ATRIA Bleeding Risk Score
Predicts major bleeding risk in patients with atrial fibrillation on warfarin anticoagulation. Complements HAS-BLED.
Score interpretation
ATRIA 0–3: Low annual bleeding risk (~0.8%). Benefits of anticoagulation outweigh risks in AF.
→ Continue or initiate anticoagulation (DOAC preferred over warfarin). Annual review. Optimise modifiable bleeding risk factors (BP, anaemia, alcohol).
ATRIA 4: Intermediate annual bleeding risk (~2.6%). Reassess risk-benefit.
→ Discuss risk-benefit with patient. Treat modifiable risk factors. Ensure BP controlled. Avoid NSAIDs/aspirin combination. DOAC preferred. 6-monthly review.
ATRIA ≥ 5: High annual bleeding risk (~5.8%). Weigh carefully against stroke risk (CHA₂DS₂-VASc).
→ Weigh ATRIA bleeding risk against CHA₂DS₂-VASc stroke risk. If CHA₂DS₂-VASc ≥ 2 (men) / ≥ 3 (women), anticoagulation still usually outweighs risk. Aggressively address modifiable factors. Consider PPI cover. Cardiology / anticoagulation clinic referral.
Interpretation bands for the ATRIA Bleeding. Apply clinical judgement and local guidance.
References
- Fang MC et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study. J Am Coll Cardiol. 2011.
Related
Curated clinical cross-links plus same-class fallbacks.
- Warfarin Dose Adjustment Calculator · Anticoagulation
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- ORBIT Bleeding Risk Score for Anticoagulation in AF Patients · Anticoagulation
- Heparin Infusion Dose Calculator · Anticoagulation
- Paediatric INR Goals for Mechanical Heart Valves · Anticoagulation
- Warfarin · Anticoagulant
- Bivalirudin (PCI Anticoagulation) · Direct Thrombin Inhibitor / PCI
- Vernakalant · Atrial-selective antiarrhythmic
- Prothrombin Complex Concentrate (PCC) · Coagulation Factor Concentrate — Warfarin Reversal
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Bivalirudin · Anticoagulation
- 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 ATRIA 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.