HEMORR₂HAGES Bleeding Risk Score
Estimates annual major bleeding risk in AF patients on anticoagulation. 11-component mnemonic score.
Score interpretation
1.9 (score 0) to 2.5 (score 1) bleeds per 100 patient-years of warfarin (Gage 2006).
→ Anticoagulation generally appropriate if CHA₂DS₂-VASc ≥2 (men) or ≥3 (women)
5.3 (score 2) to 8.4 (score 3) bleeds per 100 patient-years of warfarin (Gage 2006).
→ Weigh against stroke risk; DOAC with lowest bleeding profile; frequent monitoring
10.4 (score 4) to 12.3 (score ≥ 5) bleeds per 100 patient-years of warfarin (Gage 2006).
→ Consider withholding anticoagulation if risk exceeds benefit; modify correctable risk factors; haematology review
Interpretation bands for the HEMORR₂HAGES. Apply clinical judgement and local guidance.
References
- Gage BF, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-719.
Related
Curated clinical cross-links plus same-class fallbacks.
- Warfarin · Anticoagulant
- Bivalirudin (PCI Anticoagulation) · Direct Thrombin Inhibitor / PCI
- Prothrombin Complex Concentrate (PCC) · Coagulation Factor Concentrate — Warfarin Reversal
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Bivalirudin · Anticoagulation
- Warfarin · Vitamin K Antagonist (Anticoagulant)
- 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
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.