ATRIA Bleeding Risk Score
Determines bleeding risk for patients being considered for warfarin anticoagulation
Jennifer Glen
Provided by
EVAL FoundationMales: Hemoglobin <13 g/dL
Females: Hemoglobin <12 g/dL
Glomerular filtration rate <30mL/min or dialysis-dependent
Example: GI bleed or intracranial hemorrhage
The ATRIA Bleeding Risk Score considers major and minor risk of hemorrhage and bleeding in patients prior to beginning warfarin therapy.
- The ATRIA study included patients with non-valvular, non-transient atrial fibrillation.
- Major hemorrhage was defined as fatal, requiring transfusion of ≥2 units pRBCs, or hemorrhage into critical anatomic site (intracranial, retroperitoneal, etc.)
Criteria
| Risk Factor | Point Value |
| Anemia | 3 |
| Severe Renal Disease/Dialysis | 3 |
| Age ≥75 | 2 |
| Prior Hemorrhage | 1 |
| Hypertension | 1 |
Results
| Risk Level | Points | Annual Risk of Hemorrhage | Recommendation |
| Low Risk | <4 | 0.76% | Reasonable to start warfarin therap |
| Intermediate Risk | 4 | 2.6% | Alternatives to warfarin therapy can be considered |
| High Risk | >4 | 5.8% | Alternatives to warfarin therapy ought to be strongly considered |
All questions & possible results
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Anemia
Males: Hemoglobin <13 g/dL
Females: Hemoglobin <12 g/dL
Select one option:
- No
- Yes
Severe Renal Disease
Glomerular filtration rate <30mL/min or dialysis-dependent
Select one option:
- No
- Yes
Age ≥ 75 years
Select one option:
- No
- Yes
Any Prior Hemorrhage Diagnosis
Example: GI bleed or intracranial hemorrhage
Select one option:
- No
- Yes
Hypertension History
Select one option:
- No
- Yes
Possible results
High Risk (>4 points): Alternatives to warfarin therapy ought to be strongly considered
5.8% Annual Risk of Hemorrhage
- Carefully weigh patient specific risks and benefits of long-term warfarin therapy.
- The ATRIA risk score is one of several tools to stratify the risk of major hemorrhage in patients being considered for warfarin anticoagulation. The HAS-BLED score is another tool that may have a better prediction accuracy than ATRIA.
Low Risk (<4 points): Reasonable to start warfarin therapy
0.76% Annual Risk of Hemorrhage
- Carefully weigh patient specific risks and benefits of long-term warfarin therapy.
- The ATRIA risk score is one of several tools to stratify the risk of major hemorrhage in patients being considered for warfarin anticoagulation. The HAS-BLED score is another tool that may have a better prediction accuracy than ATRIA.
Intermediate Risk (4 points): Alternatives to warfarin therapy can be considered
2.6% Annual Risk of Hemorrhage
- Carefully weigh patient specific risks and benefits of long-term warfarin therapy.
- The ATRIA risk score is one of several tools to stratify the risk of major hemorrhage in patients being considered for warfarin anticoagulation. The HAS-BLED score is another tool that may have a better prediction accuracy than ATRIA.
Literature
- A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011 Jul 19;58(4):395-401. — Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE.
- Predictive value of the HAS-BLED and ATRIA bleeding scores for the risk of serious bleeding in a "real-world" population with atrial fibrillation receiving anticoagulant therapy. Chest. 2013 Jan;143(1):179-184. — Roldán V, Marín F, Fernández H, Manzano-Fernandez S, Gallego P, Valdés M, Vicente V, Lip GYH.
- Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin. Am J Med. 2016 Jun;129(6):600-7. — Senoo K, Proietti M, Lane DA, Lip GY.
