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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. It was mainly dependent on laboratory values like decrease in hemoglobin or hematocrit values. It has been modified over time and the most recent version is shown below.


'''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>
==TIMI Bleeding Criteria==
{{cquote|


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. It was mainly dependent on laboratory values like decrease in hemoglobin or hematocrit values. It has been modified over time and the most recent version is shown below.
===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)


{{cquote|
=====2. Minor=====
*Clinically overt (including imaging), resulting in hemoglobin drop of 3 to <5 g/dL or ≥10% decrease in [[Hematocrit|haematocrit]]
*No observed blood loss: ≥4 g/dL decrease in the haemoglobin concentration or ≥12% 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)


'''Non-CABG related bleeding'''
=====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 [[Hematocrit|haematocrit]]


*'''Major'''
===Bleeding in the setting of CABG:===
Any intracranial bleeding (excluding microhemorrhages <10 mm evident only on gradient-echo MRI)
*Fatal bleeding (bleeding that directly results in death)
Clinically overt signs of hemorrhage associated with a drop in hemoglobin of ≥5 g/dL
*Perioperative [[Intracranial hemorrhage|intracranial bleeding]]
Fatal bleeding (bleeding that directly results in death within 7 d)
*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}}


*'''Minor'''
Clinically overt (including imaging), resulting in hemoglobin drop of 3 to <5 g/dL
Requiring medical attention
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'''
Any overt bleeding event that does not meet the criteria above
'''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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Revision as of 14:48, 1 March 2012

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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. It was mainly dependent on laboratory values like decrease in hemoglobin or hematocrit values. It has 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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