TIMI bleeding criteria

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

Overview

The Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria 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

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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

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