IMPROVE Bleeding Risk Score for Hospitalised Patients
Predicts in-hospital and 14-day bleeding risk in medically ill hospitalised patients. Used alongside IMPROVE VTE score to guide pharmacological vs mechanical VTE prophylaxis decisions.
Score interpretation
IMPROVE bleeding score < 7: 1.5 % major or clinically relevant non-major bleeding in hospital (IMPROVE cohort). Use a VTE risk score (e.g. IMPROVE VTE) to decide on prophylaxis.
→ Assess IMPROVE VTE score alongside; if VTE risk elevated: pharmacological prophylaxis appropriate (adults: LMWH -- enoxaparin 40 mg SC OD; fondaparinux 2.5 mg SC OD if HIT history); ensure adequate renal dose adjustment; continue until mobility restored or discharge; reassess daily; mechanical prophylaxis (IPC or compression stockings) additionally if very high VTE risk. Children: use a children's formulary.
IMPROVE bleeding score ≥ 7: 7.9 % major or clinically relevant non-major bleeding in hospital; mechanical prophylaxis preferred where VTE prophylaxis is needed.
→ Mechanical VTE prophylaxis only: graduated compression stockings (GCS class 2) + intermittent pneumatic compression (IPC) devices; AVOID pharmacological prophylaxis if bleeding risk outweighs VTE risk; reassess daily (bleeding risk may resolve); if bleeding risk resolves (e.g., post-procedure, platelet recovery): transition to pharmacological when safe; document bleeding risk rationale in notes; early mobilisation; treat reversible bleeding risk factors (correct coagulopathy, manage thrombocytopenia); consider specialist haematology review for complex anticoagulation decisions.
Interpretation bands for the IMPROVE Bleeding. Apply clinical judgement and local guidance.
References
- Decousus H et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011;139(1):69-79.
- NICE NG89. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE. 2018 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- Enoxaparin (VTE in Pregnancy) · Low Molecular Weight Heparin (LMWH) — VTE Prophylaxis/Treatment
- Enoxaparin (Orthopaedic VTE Prophylaxis) · Low Molecular Weight Heparin (LMWH)
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Enoxaparin (VTE Prophylaxis — Post-Surgery) · Low Molecular Weight Heparin (LMWH) — VTE Prophylaxis
- Betrixaban (Extended VTE Prophylaxis — Medical Patients) · Oral Factor Xa Inhibitor (DOAC — Extended Duration)
- Enoxaparin (LMWH) · Anticoagulant
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.