_id

683a15f8c782e11e38d1b0e0

id

1718

title

ATRIA Bleeding Risk Score

full_title

ATRIA Bleeding Risk Score

short_title

ATRIA Bleeding Risk

med_description

Determines bleeding risk for patients on warfarin.

short_description

Bleeding risk from warfarin.

slug

atria-bleeding-risk-score

description

The ATRIA bleeding score Determines bleeding risk in patients on warfarin for atrial fibrillation.

keywords

hemorrhage risk calculator, bleed risk warfarin, bleed risk coumadin, atria score, atria warfarin, atria calculator, atria risk, atrial fibrillation, bleeding score, atrial fibrillation bleeding risk, bleeding score

complaint

[ "Bleeding", "Palpitations" ]

formula

Addition of the selected points:

evidence

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://content.onlinejacc.org/article.aspx?articleid=1146658", "text": "Fang MC, Go AS, Chang Y, et al. A New Risk Scheme to Predict Warfarin-Associated Hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58(4):395-401. doi:10.1016/j.jacc.2011.03.031." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/22722228", "text": "Roldán V, Marín F, Fernández H, et al. 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;143(1):179-184." }, { "href": "https://www.amjmed.com/article/S0002-9343(15)00926-2/fulltext", "text": "Senoo K, Proietti M, Lane DA, Lip GY. Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin. Am J Med. 2016;129(6):600-7." } ], "Validations": [] }

pearls

The ATRIA study sought to develop a risk stratification score to predict warfarin-associated hemorrhage.

• Included patients from the Kaiser Permanente of Northern California hospital system with non-valvular, non-transient atrial fibrillation via their ICD-9 codes and then followed up for a period of six to seven years.
• Patients randomly divided into split-sample “derivation” and “validation” cohorts, in a 2:1 ratio, respectively.
• The study sought to identify risk factors for patients with major hemorrhage, defined as fatal, requiring transfusion of ≥2 units pRBCs, or hemorrhage into critical anatomic site (intracranial, retroperitoneal, etc).
• Five variables were derived after statistical analysis and then weighed based on degree of effect.
• Scoring system consisted of five criteria, each of which was worth 1, 2, or 3 points.
• Study used ≤3 points to define low probability group (<1%) for major hemorrhage, 4 points for immediate (2.6%) and 5-10 points for high (5.8%).

Points to keep in mind:

• Patients at risk for major hemorrhage, e.g. those with past intracranial bleeds, were likely already pre-excluded by clinicians and thus not included in the study
• The derivation and validation cohorts were taken from the same patient population with excellent follow-up
• Patients’ INRs and potential for compliance were not taken into consideration
• The study did not compare the ATRIA score to the HAS-BLED score, which has been incorporated into European and Canadian atrial fibrillation guidelines
• Subsequent studies comparing the performance of the ATRIA and HAS-BLED bleeding risk-prediction scores showed that HAS-BLED had better prediction accuracy than ATRIA.

usecase

• The ATRIA risk scoring scheme, in combination with other risk stratification scores and physician gestalt, can be used to help guide the decision for warfarin therapy in patients in need of anticoagulation.
• The ATRIA risk scoring scheme may be used as one potential tool to stratify the risk of major hemorrhage in patients in whom warfarin anticoagulation is being considered.

reasons

Considers major and minor risk of hemorrhage and bleeding in patients prior to beginning warfarin therapy

next_advice

next_actions

• <4 points - low risk
• 4 points - intermediate risk
• >4 points - high risk

Patient specific risks and benefits of anticoagulation must be carefully weighed in all patients who are potential candidates for long-term warfarin therapy.

next_management

diseases

[ "Arrhythmia", "Atrial Fibrillation", "Stroke/TIA" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "Anemia", "md_calc_info_concept": null, "name": "anemia", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "Hemoglobin <13 g/dL (Male), <12 g/dL (Female)", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Severe Renal Disease", "md_calc_info_concept": null, "name": "severe_renal_disease", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 3 } ], "show_points": true, "tips_en": "Glomerular filtration rate <30 mL/min or dialysis-dependent", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Age ≥ 75 years", "md_calc_info_concept": null, "name": "age_75", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Any Prior Hemorrhage Diagnosis", "md_calc_info_concept": null, "name": "prior_hemorrhage_diagnosis", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "Ex: GI bleed, intracranial hemorrhage", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "Hypertension History", "md_calc_info_concept": null, "name": "hypertension", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

published

2022-04-21T20:28:58.509Z

purpose

[ "Prognosis" ]

search_terms

[ "coumadin", "warfarin", "afib", "stroke risk" ]

seo

{ "keywords_en": "hemorrhage risk calculator, bleed risk warfarin, bleed risk coumadin, atria score, atria warfarin, atria calculator, atria risk, atrial fibrillation, bleeding score, atrial fibrillation bleeding risk, bleeding score", "meta_description_en": "The ATRIA bleeding score Determines bleeding risk in patients on warfarin for atrial fibrillation." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Family Practice", "Internal Medicine", "Neurology", "Primary Care" ]

departments

[ "Cardiac", "Hematologic", "Neurologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1785, "short_title_en": "HEMORR₂HAGES Score", "slug": "hemorr2hages-score-major-bleeding-risk" }, { "calcId": 10504, "short_title_en": "GARFIELD-AF", "slug": "garfield-af" }, { "calcId": 807, "short_title_en": "HAS-BLED Score", "slug": "has-bled-score-major-bleeding-risk" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "hematology", "neurology" ]

cleaned_use

[ "The ATRIA risk scoring scheme, in combination with other risk stratification scores and physician gestalt, can be used to help guide the decision for warfarin therapy in patients in need of anticoagulation.", "The ATRIA risk scoring scheme may be used as one potential tool to stratify the risk of major hemorrhage in patients in whom warfarin anticoagulation is being considered." ]

pub

true