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==Overview==
The Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria <ref name="pmid21670242">{{cite journal| author=Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al.| title=Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. | journal=Circulation | year= 2011 | volume= 123 | issue= 23 | pages= 2736-47 | pmid=21670242 | doi=10.1161/CIRCULATIONAHA.110.009449 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670242  }} </ref><ref name="pmid16253582">{{cite journal| author=Rao SV, O'Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F et al.| title=Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. | journal=Am J Cardiol | year= 2005 | volume= 96 | issue= 9 | pages= 1200-6 | pmid=16253582 | doi=10.1016/j.amjcard.2005.06.056 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253582  }} </ref><ref name="pmid1906692">{{cite journal| author=Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D et al.| title=Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. | journal=Ann Intern Med | year= 1991 | volume= 115 | issue= 4 | pages= 256-65 | pmid=1906692 | doi= | pmc= | url= }} </ref><ref name="pmid17982182">{{cite journal| author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S et al.| title=Prasugrel versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 20 | pages= 2001-15 | pmid=17982182 | doi=10.1056/NEJMoa0706482 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17982182  }} </ref> is one of the most frequently used classifications in the cardiovascular trials. These criteria were developed during early TIMI trials to define minor and major hemorrhagic episodes in patients of [[ST segment elevation MI]] (STEMI) treated with a fibrinolytic drug and have been there for 30 years. In the past the criteria depended mainly on laboratory values, such as a decrease in hemoglobin or hematocrit values. The criteria have been modified over time and the most recent version is shown below.


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==TIMI Bleeding Criteria==
{{cquote|


'''TIMI Bleeding Criteria'''<ref name="pmid21670242">{{cite journal| author=Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al.| title=Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. | journal=Circulation | year= 2011 | volume= 123 | issue= 23 | pages= 2736-47 | pmid=21670242 | doi=10.1161/CIRCULATIONAHA.110.009449 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21670242  }} </ref>, <ref name="pmid16253582">{{cite journal| author=Rao SV, O'Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F et al.| title=Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. | journal=Am J Cardiol | year= 2005 | volume= 96 | issue= 9 | pages= 1200-6 | pmid=16253582 | doi=10.1016/j.amjcard.2005.06.056 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253582  }} </ref>, <ref name="pmid1906692">{{cite journal| author=Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D et al.| title=Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial. | journal=Ann Intern Med | year= 1991 | volume= 115 | issue= 4 | pages= 256-65 | pmid=1906692 | doi= | pmc= | url= }} </ref>, <ref name="pmid17982182">{{cite journal| author=Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S et al.| title=Prasugrel versus clopidogrel in patients with acute coronary syndromes. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 20 | pages= 2001-15 | pmid=17982182 | doi=10.1056/NEJMoa0706482 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17982182  }} </ref>
===Non-CABG Related Bleeding:===
 
{{cquote|


'''Non-CABG related bleeding'''
=====1. Major=====
*Any [[Intracranial hemorrhage|intracranial bleeding]] (excluding microhemorrhages <10 mm evident only on gradient-echo MRI)
*Clinically overt signs of [[hemorrhage]] associated with a drop in hemoglobin of ≥5 g/dL or a ≥15% absolute decrease in [[Hematocrit|haematocrit]]
*Fatal bleeding (bleeding that directly results in death within 7 d)


*'''Major'''
=====2. Minor=====
Any intracranial bleeding (excluding microhemorrhages <10 mm evident only on gradient-echo MRI)
*Clinically overt (including imaging), resulting in hemoglobin drop of 3 to <5 g/dL or ≥10% decrease in [[Hematocrit|haematocrit]]
Clinically overt signs of hemorrhage associated with a drop in hemoglobin of ≥5 g/dL
*No observed blood loss: ≥4 g/dL decrease in the haemoglobin concentration or ≥12% decrease in [[Hematocrit|haematocrit]]
Fatal bleeding (bleeding that directly results in death within 7 d)
*Any overt sign of [[hemorrhage]] that meets one of the following criteria and does not meet criteria for a major or minor bleeding event, as defined above
:*Requiring intervention (medical practitioner-guided medical or surgical treatment to stop or treat [[bleeding]], including temporarily or permanently discontinuing or changing the dose of a medication or study drug)
:*Leading to or prolonging hospitalization
:*Prompting evaluation (leading to an unscheduled visit to a healthcare professional and diagnostic testing, either laboratory or imaging)


*'''Minor'''
=====3. Minimal=====
Clinically overt (including imaging), resulting in hemoglobin drop of 3 to <5 g/dL
*Any overt bleeding event that does not meet the criteria above
Requiring medical attention
*Any clinically overt sign of [[haemorrhage]] (including imaging) associated with a <3 g/dL decrease in haemoglobin concentration or <9% decrease in [[Hematocrit|haematocrit]]
Any overt sign of hemorrhage that meets one of the following criteria and does not meet criteria for a major or minor
bleeding event, as defined above
Requiring intervention (medical practitioner-guided medical or surgical treatment to stop or treat bleeding, including
temporarily or permanently discontinuing or changing the dose of a medication or study drug)
Leading to or prolonging hospitalization
Prompting evaluation (leading to an unscheduled visit to a healthcare professional and diagnostic testing, either laboratory or imaging)


*'''Minimal'''
===Bleeding in the Setting of CABG:===
Any overt bleeding event that does not meet the criteria above
*Fatal bleeding (bleeding that directly results in death)
*Perioperative [[Intracranial hemorrhage|intracranial bleeding]]
*Reoperation after closure of the sternotomy incision for the purpose of controlling bleeding
*Transfusion of ≥5 U PRBCs or whole blood within a 48-h period; cell saver transfusion will not be counted in calculations of blood products.
*Chest tube output >2 L within a 24-h period}}


'''Bleeding in the setting of CABG'''
Fatal bleeding (bleeding that directly results in death)
Perioperative intracranial bleeding
Reoperation after closure of the sternotomy incision for the purpose of controlling bleeding
Transfusion of ≥5 U PRBCs or whole blood within a 48-h period; cell saver transfusion will not be counted in calculations of
blood products.
Chest tube output >2 L within a 24-h period}}
== References ==
== References ==
{{Reflist}}
{{Reflist|2}}
 
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== See also ==
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* [[Aneurysm]]
* [[Coagulation]]
* [[Upper gastrointestinal bleed]]
* [[Vaginal bleeding]]
* [[Intracerebral hemorrhage]] - bleeding in the brain caused by the rupture of a blood vessel within the head. See also [[hemorrhagic stroke]].
* [[Subarachnoid hemorrhage]] (SAH) implies the presence of blood within the [[subarachnoid space]] from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or [[arteriovenous malformation]](AVM). The scope of this article is limited to these nontraumatic hemorrhages.
* [[Intracranial hemorrhage]]
* [[Cerebral hemorrhage]]
* [[Postpartum hemorrhage]]
* [[Hematuria]] - blood in the urine from urinary bleeding
* [[Hemoptysis]] - coughing up blood from the lungs
* [[Hematemesis]] - vomiting fresh blood
* [[Hematochezia]] - rectal blood
* [[Exsanguination]] - death by bleeding
<br>
{{SIB}}


[[Category:Medical emergencies]]
[[Category:Medical emergencies]]
[[Category:Blood]]
[[Category:Blood]]
[[Category:Hematology]]
[[Category:Hematology]]
[[bg:Кръвоизлив]]
[[bs:Krvarenje]]
[[ca:Hemorràgia]]
[[cs:Krvácení]]
[[de:Blutung]]
[[es:Hemorragia]]
[[eu:Odoljario]]
[[fr:Hémorragie]]
[[it:Emorragia]]
[[he:דימום]]
[[la:Haemorrhagia]]
[[lt:Kraujavimas]]
[[nl:Versterkte bloedingsneiging]]
[[ja:出血]]
[[pl:Krwotok]]
[[pt:Hemorragia]]
[[ro:Hemoragie]]
[[qu:Yawar apariy]]
[[ru:Кровотечение]]
[[sv:Blödning]]
{{WH}}
{{WS}}

Latest revision as of 00:25, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria [1][2][3][4] is one of the most frequently used classifications in the cardiovascular trials. These criteria were developed during early TIMI trials to define minor and major hemorrhagic episodes in patients of ST segment elevation MI (STEMI) treated with a fibrinolytic drug and have been there for 30 years. In the past the criteria depended mainly on laboratory values, such as a decrease in hemoglobin or hematocrit values. The criteria have been modified over time and the most recent version is shown below.

TIMI Bleeding Criteria

“

Non-CABG Related Bleeding:

1. Major
  • Any intracranial bleeding (excluding microhemorrhages <10 mm evident only on gradient-echo MRI)
  • Clinically overt signs of hemorrhage associated with a drop in hemoglobin of ≥5 g/dL or a ≥15% absolute decrease in haematocrit
  • Fatal bleeding (bleeding that directly results in death within 7 d)
2. Minor
  • Clinically overt (including imaging), resulting in hemoglobin drop of 3 to <5 g/dL or ≥10% decrease in haematocrit
  • No observed blood loss: ≥4 g/dL decrease in the haemoglobin concentration or ≥12% decrease in haematocrit
  • Any overt sign of hemorrhage that meets one of the following criteria and does not meet criteria for a major or minor bleeding event, as defined above
  • Requiring intervention (medical practitioner-guided medical or surgical treatment to stop or treat bleeding, including temporarily or permanently discontinuing or changing the dose of a medication or study drug)
  • Leading to or prolonging hospitalization
  • Prompting evaluation (leading to an unscheduled visit to a healthcare professional and diagnostic testing, either laboratory or imaging)
3. Minimal
  • Any overt bleeding event that does not meet the criteria above
  • Any clinically overt sign of haemorrhage (including imaging) associated with a <3 g/dL decrease in haemoglobin concentration or <9% decrease in haematocrit

Bleeding in the Setting of CABG:

  • Fatal bleeding (bleeding that directly results in death)
  • Perioperative intracranial bleeding
  • Reoperation after closure of the sternotomy incision for the purpose of controlling bleeding
  • Transfusion of ≥5 U PRBCs or whole blood within a 48-h period; cell saver transfusion will not be counted in calculations of blood products.
  • Chest tube output >2 L within a 24-h period
 ”

References

  1. ↑ Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J; et al. (2011). "Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium". Circulation. 123 (23): 2736–47. doi:10.1161/CIRCULATIONAHA.110.009449. PMID 21670242.
  2. ↑ Rao SV, O'Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F; et al. (2005). "Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes". Am J Cardiol. 96 (9): 1200–6. doi:10.1016/j.amjcard.2005.06.056. PMID 16253582.
  3. ↑ Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D; et al. (1991). "Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial". Ann Intern Med. 115 (4): 256–65. PMID 1906692.
  4. ↑ Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S; et al. (2007). "Prasugrel versus clopidogrel in patients with acute coronary syndromes". N Engl J Med. 357 (20): 2001–15. doi:10.1056/NEJMoa0706482. PMID 17982182.

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