International Society on Thrombosis and Haemostasis bleeding scale: Difference between revisions

	Bleeding Microchapters
Home
Patient Information
Overview
Classification
Bleeding Academic Research Consortium
TIMI bleeding criteria
GUSTO bleeding criteria
CURE bleeding criteria
ACUITY HORIZONS bleeding criteria
STEEPLE bleeding criteria
PLATO bleeding criteria
GRACE bleeding criteria
Causes
Treatment
Emergency Bleeding Control
Reversal of Anticoagulation and Antiplatelet in Active Bleed
Perioperative Bleeding
Anemia Management
Coagulation Monitoring
Coagulation Management
Discontinuation, Bridging, and Reversal of Anticoagulation and Antiplatelet Therapy Antiplatelet Agents Heparin Fondaparinux Vitamin K Antagonists New Oral Anticoagulants Comorbidities Involving Hemostatic Derangement
Specific Surgeries Cardiovascular Surgery Gynecological Bleeding Obstetric Bleeding Orthopedic/Neurosurgery Visceral/Transplant Surgery Pediatric Surgery
Congenital Bleeding Disorders von Willebrand Disease Platelet Defects Hemophilia A and B Factor VII Deficiency Rare Bleeding Disorders
International Society on Thrombosis and Haemostasis bleeding scale On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of International Society on Thrombosis and Haemostasis bleeding scale All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on International Society on Thrombosis and Haemostasis bleeding scale
CDC on International Society on Thrombosis and Haemostasis bleeding scale
International Society on Thrombosis and Haemostasis bleeding scale in the news
Blogs on International Society on Thrombosis and Haemostasis bleeding scale
Directions to Hospitals Treating Bleeding
Risk calculators and risk factors for International Society on Thrombosis and Haemostasis bleeding scale

← Older edit

VisualWikitext

Latest revision as of 20:29, 22 April 2014

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

Overview

The International Society on Thrombosis and Haemostasis (ISTH)/Scientific and Standardization Committee (SSC) definitions and bleeding assessment tool are useful for standardizing the reporting of bleeding symptoms.

ISTH Definitions of Bleeding

Major bleeding has been used as a primary endpoint for the evaluation of safety in clinical trials. The ISTH definitions of major bleeding in non-surgical and surgical patients are as follows:

Major Bleeding in Non-Surgical Patients^[1]

“

1. Fatal bleeding.

and/or

2. Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome.

and/or

3. Bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells.

”

Major Bleeding in Surgical Patients^[2]

“

1. Fatal bleeding.

and/or

2. Bleeding that is symptomatic and occurs in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, pericardial, in a non-operated joint, or intramuscular with compartment syndrome, assessed in consultation with the surgeon.

and/or

3. Extrasurgical site bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells, with temporal association within 24–48 h to the bleeding.

and/or

4. Surgical site bleeding that requires a second intervention (open, arthroscopic, endovascular) or a hemarthrosis of sufficient size as to interfere with rehabilitation by delaying mobilization or delayed wound healing, resulting in prolonged hospitalization or a deep wound infection.

and/or

5. Surgical site bleeding that is unexpected and prolonged and/ or sufficiently large to cause hemodynamic instability, as assessed by the surgeon. There should be an associate fall in hemoglobin level of at least 2 g/dL (1.24 mmol/L), or transfusion, indicated by the bleeding, of at least two units of whole blood or red cells, with temporal association within 24 h to the bleeding.

6. The period for collection of these data is from start of surgery until five half-lives after the last dose of the drug with the longest half-life and with the longest treatment period (in case of unequal active treatment durations).

7. The population is those who have received at least one dose of the study drug.

”

Minor Bleeding

All non-major bleeds will be considered minor bleeds. Minor bleeds will be further divided into those that are clinically relevant and those that are not.

Clinically Relevant Minor Bleed

A clinically relevant minor bleed is an acute or subacute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following:

A hospital admission for bleeding, or
A physician guided medical or surgical treatment for bleeding, or
A change in antithrombotic therapy (including interruption or discontinuation of study drug).

ISTH/SSC Bleeding Score

The ISTH/SSC proposed a bleeding assessment tool to standardize the reporting of bleeding symptoms in both pediatric and adult populations. It facilitates the diagnosis of less symptomatic mild bleeding disorder and the grading of severity in patients with known inherited bleeding disorders. For each specific bleeding symptom, a score of 1 or more is classified as significant. Scores and descriptions of bleeding symptoms are as follows:^[3]

Symptoms	Score
Symptoms	0	1	2	3	4
Epistaxis	No/trivial	>5 year or more than 10 mintues	Consultation only	Packing or cauterization or antifibrinolytic	Blood transfusion or replacement therapy (use of hemostatic blood components and rFVIIa) or desmopressin
Cutaneous	No/trivial	For bruises 5 or more (>1 cm) in exposed areas	Consultation only	Extensive	Spontaneous hematoma requiring blood transfusion
Minor wounds	No/trivial	>5 year or more than 10 mintues	Consultation only	Surgical hemostasis	Blood transfusion, replacement therapy, or desmopressin
Oral cavity	No/trivial	Present	Consultation only	Surgical hemostasis or antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
GI bleeding	No/trivial	Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia)	Consultation only	Surgical hemostasis, antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
Hematuria	No/trivial	Present (macroscopic)	Consultation only	Surgical hemostasis, iron therapy	Blood transfusion, replacement therapy or desmopressin
Tooth extraction	No/trivial or none done	Reported in ≤25% of all procedures, no intervention	Reported in >25% of all procedures, no intervention	Resuturing or packing	Blood transfusion, replacement therapy or desmopressin
Surgery	No/trivial or none done	Reported in ≤25% of all procedures, no intervention	Reported in >25% of all procedures, no intervention	Surgical hemostasis or antifibrinolytic	Blood transfusion, replacement therapy or desmopressin
Menorrhagia	No/trivial	Consultation only or Changing pads more frequently than every 2 hours or Clot and flooding or PBAC score >100	Time off work/school >2/year or Requiring antifibrinolytics or hormonal or iron therapy	Requiring combined treatment with antifibrinolytics and hormonal therapy or Present since menarche and > 12 months	Acute menorrhagia requiring hospital admission and emergency treatment or Requiring blood transfusion, Replacement therapy, Desmopressin or Requiring dilatation & curretage or endometrial ablation or hysterectomy)
Post-partum hemorrhage	No/trivial or no deliveries	Consultation only or Use of syntocin or Lochia > 6 weeks	Iron therapy or Antifibrinolytics	Requiring blood transfusion, replacement therapy, desmopressin or Requiring examination under anaesthesia and/or the use of uterin balloon/package to tamponade the uterus	Any procedure requiring critical care or surgical intervention (e.g. hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace sutures)
Muscle hematomas	Never	Post trauma, no therapy	Spontaneous, no therapy	Spontaneous or traumatic, requiring desmopressin or replacement therapy	Spontaneous or traumatic, requiring surgical intervention or blood transfusion
Hemarthrosis	Never	Post trauma, no therapy	Spontaneous, no therapy	Spontaneous or traumatic, requiring desmopressin or replacement therapy	Spontaneous or traumatic, requiring surgical intervention or blood transfusion
CNS bleeding	Never	—	—	Subdural, any intervention	Intracerebral, any intervention
Other bleedings	No/trivial	Present	Consultation only	Surgical hemostasis, antifibrinolytics	Blood transfusion or replacement therapy or desmopressin

References

↑ Schulman, S.; Kearon, C. (2005). "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients". J Thromb Haemost. 3 (4): 692–4. doi:10.1111/j.1538-7836.2005.01204.x. PMID 15842354. Unknown parameter |month= ignored (help)
↑ Schulman, S.; Angerås, U.; Bergqvist, D.; Eriksson, B.; Lassen, MR.; Fisher, W. (2010). "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients". J Thromb Haemost. 8 (1): 202–4. doi:10.1111/j.1538-7836.2009.03678.x. PMID 19878532. Unknown parameter |month= ignored (help)
↑ Rodeghiero, F.; Tosetto, A.; Abshire, T.; Arnold, DM.; Coller, B.; James, P.; Neunert, C.; Lillicrap, D. (2010). "ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders". J Thromb Haemost. 8 (9): 2063–5. doi:10.1111/j.1538-7836.2010.03975.x. PMID 20626619. Unknown parameter |month= ignored (help)

[Schulman-2005-1] Schulman, S.; Kearon, C. (2005). "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients". J Thromb Haemost. 3 (4): 692–4. doi:10.1111/j.1538-7836.2005.01204.x. PMID 15842354. Unknown parameter |month= ignored (help)

[Schulman-2010-2] Schulman, S.; Angerås, U.; Bergqvist, D.; Eriksson, B.; Lassen, MR.; Fisher, W. (2010). "Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients". J Thromb Haemost. 8 (1): 202–4. doi:10.1111/j.1538-7836.2009.03678.x. PMID 19878532. Unknown parameter |month= ignored (help)

[Rodeghiero-2010-3] Rodeghiero, F.; Tosetto, A.; Abshire, T.; Arnold, DM.; Coller, B.; James, P.; Neunert, C.; Lillicrap, D. (2010). "ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders". J Thromb Haemost. 8 (9): 2063–5. doi:10.1111/j.1538-7836.2010.03975.x. PMID 20626619. Unknown parameter |month= ignored (help)

[1]

[2]

[3]

@@ Line 7: / Line 7: @@
 The International Society on Thrombosis and Haemostasis (ISTH)/Scientific and Standardization Committee (SSC) definitions and bleeding assessment tool are useful for standardizing the reporting of bleeding symptoms.
-==ISTH Definitions of Major Bleeding==
+==ISTH Definitions of Bleeding==
-===ISTH Definitions of Major Bleeding in Non-Surgical Patients<SMALL><ref name="Schulman-2005">{{Cite journal  | last1 = Schulman | first1 = S. | last2 = Kearon | first2 = C. | title = Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. | journal = J Thromb Haemost | volume = 3 | issue = 4 | pages = 692-4 | month = Apr | year = 2005 | doi = 10.1111/j.1538-7836.2005.01204.x | PMID = 15842354 }}</ref></SMALL>===
+Major bleeding has been used as a primary endpoint for the evaluation of safety in clinical trials. The ISTH definitions of major bleeding in non-surgical and surgical patients are as follows:
+====Major Bleeding in Non-Surgical Patients<SMALL><ref name="Schulman-2005">{{Cite journal  | last1 = Schulman | first1 = S. | last2 = Kearon | first2 = C. | title = Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. | journal = J Thromb Haemost | volume = 3 | issue = 4 | pages = 692-4 | month = Apr | year = 2005 | doi = 10.1111/j.1538-7836.2005.01204.x | PMID = 15842354 }}</ref></SMALL>====
 <div style="font-size: 90%;">
 {{cquote|
-'''1. Fatal bleeding'''
+. Fatal bleeding.
 and/or
-'''2. Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome'''
+. Symptomatic bleeding in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, intraarticular or pericardial, or intramuscular with compartment syndrome.
 and/or
-'''3. Bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells'''}}
+. Bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells.}}
 </div>
-===ISTH Definitions of Major Bleeding in Surgical Patients<SMALL><ref name="Schulman-2010">{{Cite journal  | last1 = Schulman | first1 = S. | last2 = Angerås | first2 = U. | last3 = Bergqvist | first3 = D. | last4 = Eriksson | first4 = B. | last5 = Lassen | first5 = MR. | last6 = Fisher | first6 = W. | title = Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. | journal = J Thromb Haemost | volume = 8 | issue = 1 | pages = 202-4 | month = Jan | year = 2010 | doi = 10.1111/j.1538-7836.2009.03678.x | PMID = 19878532 }}</ref></SMALL>===
+====Major Bleeding in Surgical Patients<SMALL><ref name="Schulman-2010">{{Cite journal  | last1 = Schulman | first1 = S. | last2 = Angerås | first2 = U. | last3 = Bergqvist | first3 = D. | last4 = Eriksson | first4 = B. | last5 = Lassen | first5 = MR. | last6 = Fisher | first6 = W. | title = Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. | journal = J Thromb Haemost | volume = 8 | issue = 1 | pages = 202-4 | month = Jan | year = 2010 | doi = 10.1111/j.1538-7836.2009.03678.x | PMID = 19878532 }}</ref></SMALL>====
 <div style="font-size: 90%;">
 {{cquote|
-'''1. Fatal bleeding'''
+. Fatal bleeding.
 and/or
-'''2. Bleeding that is symptomatic and occurs in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, pericardial, in a non-operated joint, or intramuscular with compartment syndrome, assessed in consultation with the surgeon'''
+. Bleeding that is symptomatic and occurs in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, pericardial, in a non-operated joint, or intramuscular with compartment syndrome, assessed in consultation with the surgeon.
 and/or
-'''3. Extrasurgical site bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells, with temporal association within 24–48 h to the bleeding'''
+. Extrasurgical site bleeding causing a fall in hemoglobin level of 2 g/dL (1.24 mmol/L) or more, or leading to transfusion of two or more units of whole blood or red cells, with temporal association within 24–48 h to the bleeding.
 and/or
-'''4. Surgical site bleeding that requires a second intervention (open, arthroscopic, endovascular) or a hemarthrosis of sufficient size as to interfere with rehabilitation by delaying mobilization or delayed wound healing, resulting in prolonged hospitalization or a deep wound infection'''
+. Surgical site bleeding that requires a second intervention (open, arthroscopic, endovascular) or a hemarthrosis of sufficient size as to interfere with rehabilitation by delaying mobilization or delayed wound healing, resulting in prolonged hospitalization or a deep wound infection.
 and/or
-'''5. Surgical site bleeding that is unexpected and prolonged and/ or sufficiently large to cause hemodynamic instability, as assessed by the surgeon. There should be an associate fall in hemoglobin level of at least 2 g/dL (1.24 mmol/L), or transfusion, indicated by the bleeding, of at least two units of whole blood or red cells, with temporal association within 24 h to the bleeding.'''
+. Surgical site bleeding that is unexpected and prolonged and/ or sufficiently large to cause hemodynamic instability, as assessed by the surgeon. There should be an associate fall in hemoglobin level of at least 2 g/dL (1.24 mmol/L), or transfusion, indicated by the bleeding, of at least two units of whole blood or red cells, with temporal association within 24 h to the bleeding.
-'''6. The period for collection of these data is from start of surgery until five half-lives after the last dose of the drug with the longest half-life and with the longest treatment period (in case of unequal active treatment durations).'''
+. The period for collection of these data is from start of surgery until five half-lives after the last dose of the drug with the longest half-life and with the longest treatment period (in case of unequal active treatment durations).
-'''7. The population is those who have received at least one dose of the study drug.'''}}
+. The population is those who have received at least one dose of the study drug.}}
 </div>
+====Minor Bleeding====
+All non-major bleeds will be considered minor bleeds. Minor bleeds will be further divided into those that are clinically relevant and those that are not.
+====Clinically Relevant Minor Bleed====
+A clinically relevant minor bleed is an acute or subacute clinically overt bleed that does not meet the criteria for a major bleed but prompts a clinical response, in that it leads to at least one of the following:
+* A hospital admission for bleeding, or
+* A physician guided medical or surgical treatment for bleeding, or
+* A change in antithrombotic therapy (including interruption or discontinuation of study drug).
 ==ISTH/SSC Bleeding Score==
-The ISTH/SSC Joint Working Group proposed a bleeding assessment tool to standardize the reporting of bleeding symptoms in both pediatric and adult populations. It facilitates the diagnosis of less symptomatic mild bleeding disorder and the grading of severity in patients with known inherited bleeding disorders. For each specific bleeding symptom, a score of 1 or more is classified as significant. Scores and descriptions of bleeding symptoms are as follows:<ref name="Rodeghiero-2010">{{Cite journal  | last1 = Rodeghiero | first1 = F. | last2 = Tosetto | first2 = A. | last3 = Abshire | first3 = T. | last4 = Arnold | first4 = DM. | last5 = Coller | first5 = B. | last6 = James | first6 = P. | last7 = Neunert | first7 = C. | last8 = Lillicrap | first8 = D. | title = ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. | journal = J Thromb Haemost | volume = 8 | issue = 9 | pages = 2063-5 | month = Sep | year = 2010 | doi = 10.1111/j.1538-7836.2010.03975.x | PMID = 20626619 }}</ref>
+The ISTH/SSC proposed a bleeding assessment tool to standardize the reporting of bleeding symptoms in both pediatric and adult populations. It facilitates the diagnosis of less symptomatic mild bleeding disorder and the grading of severity in patients with known inherited bleeding disorders. For each specific bleeding symptom, a score of 1 or more is classified as significant. Scores and descriptions of bleeding symptoms are as follows:<ref name="Rodeghiero-2010">{{Cite journal  | last1 = Rodeghiero | first1 = F. | last2 = Tosetto | first2 = A. | last3 = Abshire | first3 = T. | last4 = Arnold | first4 = DM. | last5 = Coller | first5 = B. | last6 = James | first6 = P. | last7 = Neunert | first7 = C. | last8 = Lillicrap | first8 = D. | title = ISTH/SSC bleeding assessment tool: a standardized questionnaire and a proposal for a new bleeding score for inherited bleeding disorders. | journal = J Thromb Haemost | volume = 8 | issue = 9 | pages = 2063-5 | month = Sep | year = 2010 | doi = 10.1111/j.1538-7836.2010.03975.x | PMID = 20626619 }}</ref>
 {| style="border: 2px solid #A8A8A8; font-size: 90%;"
-| align="center" style="background: #DCDCDC; width: 50px;" rowspan=2 | '''Symptoms'''
+| align="center" style="background: #DCDCDC; width: 50px;" rowspan=2 | Symptoms
-| align="center" style="background: #DCDCDC;" colspan=5 | '''Score'''
+| align="center" style="background: #DCDCDC;" colspan=5 | Score
 |-
-| align="center" style="background: #DCDCDC; width: 200px;" | '''<font color="#000000">0</font>'''
+| align="center" style="background: #DCDCDC; width: 200px;" | <font color="#000000">0</font>
-| align="center" style="background: #DCDCDC; width: 200px;" | '''<font color="#000000">1</font>'''
+| align="center" style="background: #DCDCDC; width: 200px;" | <font color="#000000">1</font>
-| align="center" style="background: #DCDCDC; width: 200px;" | '''<font color="#000000">2</font>'''
+| align="center" style="background: #DCDCDC; width: 200px;" | <font color="#000000">2</font>
-| align="center" style="background: #DCDCDC; width: 200px;" | '''<font color="#000000">3</font>'''
+| align="center" style="background: #DCDCDC; width: 200px;" | <font color="#000000">3</font>
-| align="center" style="background: #DCDCDC; width: 200px;" | '''<font color="#000000">4</font>'''
+| align="center" style="background: #DCDCDC; width: 200px;" | <font color="#000000">4</font>
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Epistaxis'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Epistaxis
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | >5 year <u>'''or'''</u>  more than 10 mintues
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | >5 year <u>or</u>  more than 10 mintues
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Packing <u>'''or'''</u>  cauterization <u>'''or'''</u>  antifibrinolytic
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Packing <u>or</u>  cauterization <u>or</u>  antifibrinolytic
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion <u>'''or'''</u>  replacement therapy (use of hemostatic blood components and rFVIIa) <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion <u>or</u>  replacement therapy (use of hemostatic blood components and rFVIIa) <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Cutaneous'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Cutaneous
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | For bruises 5 <u>'''or'''</u>  more (>1 cm) in exposed areas
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | For bruises 5 <u>or</u>  more (>1 cm) in exposed areas
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Extensive
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous hematoma requiring blood transfusion
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Minor wounds'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Minor wounds
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | >5 year <u>'''or'''</u>  more than 10 mintues
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | >5 year <u>or</u>  more than 10 mintues
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy, <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy, <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Oral cavity'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Oral cavity
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Present
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis <u>'''or'''</u>  antifibrinolytic
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis <u>or</u>  antifibrinolytic
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''GI bleeding'''
+| align="center" style="background: #DCDCDC; width: 150px;" | GI bleeding
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Present (not associated with ulcer, portal hypertension, hemorrhoids, angiodysplasia)
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis, antifibrinolytic
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Hematuria'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Hematuria
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Present (macroscopic)
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis, iron therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Tooth extraction'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Tooth extraction
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>'''or'''</u>  none done
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>or</u>  none done
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Reported in ≤25% of all procedures, no intervention
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Reported in >25% of all procedures, no intervention
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Resuturing <u>'''or'''</u>  packing
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Resuturing <u>or</u>  packing
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Surgery'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Surgery
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>'''or'''</u>  none  done
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>or</u>  none  done
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Reported in ≤25% of all procedures, no intervention
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Reported in >25% of all procedures, no intervention
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis <u>'''or'''</u>  antifibrinolytic
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis <u>or</u>  antifibrinolytic
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion, replacement therapy <u>or</u>  desmopressin
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Menorrhagia'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Menorrhagia
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only <u>'''or'''</u>  Changing pads more frequently than every 2 hours <u>'''or'''</u>  Clot and flooding <u>'''or'''</u>  PBAC score >100
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only <u>or</u>  Changing pads more frequently than every 2 hours <u>or</u>  Clot and flooding <u>or</u>  PBAC score >100
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Time off work/school >2/year <u>'''or'''</u>  Requiring antifibrinolytics <u>'''or'''</u>  hormonal <u>'''or'''</u>  iron therapy
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Time off work/school >2/year <u>or</u>  Requiring antifibrinolytics <u>or</u>  hormonal <u>or</u>  iron therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Requiring combined treatment with antifibrinolytics and hormonal therapy <u>'''or'''</u>  Present since menarche and > 12 months
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Requiring combined treatment with antifibrinolytics and hormonal therapy <u>or</u>  Present since menarche and > 12 months
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Acute menorrhagia requiring hospital admission and emergency treatment <u>'''or'''</u>  Requiring blood transfusion, Replacement therapy, Desmopressin <u>'''or'''</u>  Requiring dilatation & curretage <u>'''or'''</u>  endometrial ablation <u>'''or'''</u>  hysterectomy)
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Acute menorrhagia requiring hospital admission and emergency treatment <u>or</u>  Requiring blood transfusion, Replacement therapy, Desmopressin <u>or</u>  Requiring dilatation & curretage <u>or</u>  endometrial ablation <u>or</u>  hysterectomy)
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Post-partum hemorrhage'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Post-partum hemorrhage
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>'''or'''</u>  no deliveries
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial <u>or</u>  no deliveries
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only <u>'''or'''</u>  Use of syntocin <u>'''or'''</u>  Lochia > 6 weeks
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only <u>or</u>  Use of syntocin <u>or</u>  Lochia > 6 weeks
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Iron therapy <u>'''or'''</u>  Antifibrinolytics
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Iron therapy <u>or</u>  Antifibrinolytics
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Requiring blood transfusion, replacement therapy, desmopressin <u>'''or'''</u>  Requiring examination under anaesthesia and/or the use of uterin balloon/package to tamponade the uterus
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Requiring blood transfusion, replacement therapy, desmopressin <u>or</u>  Requiring examination under anaesthesia and/or the use of uterin balloon/package to tamponade the uterus
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Any procedure requiring critical care <u>'''or'''</u>  surgical intervention (e.g. hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace  sutures)
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Any procedure requiring critical care <u>or</u>  surgical intervention (e.g. hysterectomy, internal iliac artery legation, uterine artery embolization, uterine brace  sutures)
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Muscle hematomas'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Muscle hematomas
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Never
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Post trauma, no therapy
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous, no therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>'''or'''</u>  traumatic, requiring desmopressin <u>'''or'''</u>  replacement therapy
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>or</u>  traumatic, requiring desmopressin <u>or</u>  replacement therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>'''or'''</u>  traumatic, requiring surgical intervention <u>'''or'''</u>  blood transfusion
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>or</u>  traumatic, requiring surgical intervention <u>or</u>  blood transfusion
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Hemarthrosis'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Hemarthrosis
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Never
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Post trauma, no therapy
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous, no therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>'''or'''</u>  traumatic, requiring desmopressin <u>'''or'''</u>  replacement therapy
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>or</u>  traumatic, requiring desmopressin <u>or</u>  replacement therapy
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>'''or'''</u>  traumatic, requiring surgical intervention <u>'''or'''</u>  blood transfusion
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Spontaneous <u>or</u>  traumatic, requiring surgical intervention <u>or</u>  blood transfusion
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''CNS bleeding'''
+| align="center" style="background: #DCDCDC; width: 150px;" | CNS bleeding
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Never
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | —
@@ Line 156: / Line 169: @@
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Intracerebral, any intervention
 |-
-| align="center" style="background: #DCDCDC; width: 150px;" | '''Other bleedings'''
+| align="center" style="background: #DCDCDC; width: 150px;" | Other bleedings
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | No/trivial
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Present
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Consultation only
 | align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Surgical hemostasis, antifibrinolytics
-| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion <u>'''or'''</u>  replacement therapy <u>'''or'''</u>  desmopressin
+| align="left" style="background: #F8F8F8; width: 200px; padding: 5px;" valign=top | Blood transfusion <u>or</u>  replacement therapy <u>or</u>  desmopressin
 |}

International Society on Thrombosis and Haemostasis bleeding scale: Difference between revisions

Latest revision as of 20:29, 22 April 2014

Overview

ISTH Definitions of Bleeding

Major Bleeding in Non-Surgical Patients[1]

Major Bleeding in Surgical Patients[2]

Minor Bleeding

Clinically Relevant Minor Bleed

ISTH/SSC Bleeding Score

References

Navigation menu

Search

Major Bleeding in Non-Surgical Patients^[1]

Major Bleeding in Surgical Patients^[2]