Cardiology Emergency Medicine Strong — derived and validated in >89,000 NSTEMI patients

CRUSADE Bleeding Risk Score

Estimates the risk of in-hospital major bleeding in patients with NSTEMI/ACS. Considers haematocrit, creatinine clearance, heart rate, sex, signs of heart failure, prior vascular disease, diabetes, and SBP.

Score interpretation

Very Low Bleeding Risk — ~3.1% 0–20

CRUSADE ≤ 20: Very low risk of in-hospital major bleeding (~3.1%).

→ Standard ACS management. Full anticoagulation and antiplatelet therapy as per NSTEMI guidelines.

Low Bleeding Risk — ~5.5% 21–30

CRUSADE 21–30: Low bleeding risk (~5.5%).

→ Proceed with standard NSTEMI anticoagulation. Monitor for bleeding signs.

Moderate Bleeding Risk — ~8.6% 31–40

CRUSADE 31–40: Moderate bleeding risk (~8.6%).

→ Use lowest effective anticoagulant doses. Consider radial access for PCI. Avoid GPIIb/IIIa inhibitors unless strongly indicated.

High Bleeding Risk — ~11.9% 41–50

CRUSADE 41–50: High bleeding risk (~11.9%).

→ Radial access preferred. Bivalirudin over UFH if available. Minimise dual antiplatelet duration post-PCI. Senior cardiology input.

Very High Bleeding Risk — >19.5% 51–100

CRUSADE > 50: Very high bleeding risk (>19.5%).

→ Carefully weigh ischaemic vs bleeding risk. Conservative strategy may be preferable. Multidisciplinary decision. PPI prophylaxis. Daily haematocrit monitoring.

Interpretation bands for the CRUSADE. Apply clinical judgement and local guidance.

References

Subherwal S, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE Bleeding Score. Circulation. 2009;119(14):1873–1882.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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