How long do you have to put pressure on the venipuncture site of a patient on anticoagulant therapy?

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RISK PREDICTION TOOLS FOR ANTICOAGULANT-ASSOCIATED HEMORRHAGE

Risk Scheme	Study Description	Risk Score Calculation	Hemorrhage Outcomes	RiskCategories (points)	Number of patients (%)	MajorBleedingRates inOriginal Cohort	MajorBleedingRatesin Other Studies
Outpatient Bleeding Risk Index,OBRI(Landefeld, 1989)[25]	Developed in 565 patients with cardiac surgery, atrial ibrillation, or venous thromboemboli sm newly starting warfarin on hospital discharge and followed for 48 months. Most common indication was cardiac surgery.	1 point for each of the following: age ≥ 65 years, prior stroke, prior GI bleeding 1 point if any of the following: recent myocardial infarction, diabetes mellitus, hematocrit<30 %, creatinine>1.5 mg/dL	Major bleeding: fatal, life-threatening, potentially life-threatening, led to severe blood loss, led to surgical treatment or led to moderate blood loss	Low(0)Intermediate (1–2) High (3–4)	164 (31%)331 (58%) 61 (11%)	3% at 12 months11% at 12 months 17% at 12 months	3% at 12months7.6% at 12 months 8.6% at 12 months
Modified Outpatient Bleeding Risk Index, mOBRI (Beyth, 1998) [14]	Refinement of previous OBRI in 565 patients with cardiac surgery, atrial fibrillation, or venous thromboemboli sm newly starting warfarin on hospital discharge and followed for 48 months. Most common indication was cardiac surgery. Then prospectively tested in 264 patients in a separate cohort	1 point for each of the following: age ≥ 65 years, prior stroke, prior GI bleeding 1 point if any of the following: recent myocardial infarction, diabetes mellitus, hematocrit<30 %, creatinine>1.5 mg/dL	Major bleeding: overt bleeding leading to a loss of at least 2.0 units in 7 days or less, or life-threatening	Low (0)Intermediate (1–2) High (3–4)	186 (33%)336 (59%) 34 (6%)	3% at 12 months12% at 12 months 48% at 12 months	0–1.5% per year2–5% per year 0–11% per year
Kuijer, 1999[26]	Developed in 241 patients with new venous thromboemboli sm enrolled in a clinical trial and followed for 3 months.	Age>60 years (1.6 points), female sex (1.3 points), presence of malignancy (2.2 points)	Major bleeding: clinically overt and associated with a decline in hemoglobin concentration of at least 20 g/l, need for transfusion of 2 units or more of red blood cells, retroperitoneal or intracranial, warranted permanent discontinuation of treatment	Low (0)Intermediate (>0 and <3) High (≥3)	170 (22%)460 (59%) 150 (19%)	0.5% at 3 months1.7% at 3 months 7% at 3 months	0.6% at 3 months1.5–4.4% at 3 months 1.8–7% at 3 months
Kearon, 2003 [32]	Developed in patients with acute venous thromboemboli sm enrolled in a clinical trial	1 point for each of the following: age >= 65, prior stroke, prior peptic ulcer disease, prior GI bleeding, creatinine > 1.5, anemia or thrombocytope nia, liver disease, diabetes mellitus	Prospectively determined major bleeding: clinically overt and decrease in Hgb >= 2.0 g/dL, transfusion of >=2 units PRBCS, or in a critical site	Low (0–1)Intermediate (2–3) High (>=4)	654 (89%) 84 (11%)	0.2–2.0 per 100 person-years 1.0–2.3 per 100 person-years	0.6–2.5 per 100 person-years2.3–9.3 per 100 person-years 5.5–15.3 per 100 person-years
HEMORR2HA GES (Gage, 2006) [28]	Developed from the National Registry of Atrial Fibrillation (NRAF) in 3791 hospitalized Medicare patients with atrial fibrillation discharged on warfarin and followed for 36 months.	1 point for each of the following: hepatic or renal disease, alcohol abuse, malignancy, age >75 years, reduced platelet count or function, hypertension (uncontrolled), anemia, genetic factors, excessive fall risk, and stroke. 2 points for: previous hemorrhage	Authors used ICD-9-CM codes for bleed in any location	Low (0–1)Intermediate (2–3) High (≥ 4)	717 (45%)694 (43%) 193 (19%)	2% at 12 months5% at 12 months 9% at 12 months	0.7–2.5% per year2.5–8.4% per year 4.0–12.3% per year
Shireman, 2006 [27]	Developed from 26,345 hospitalized Medicare patients older than 65 years with atrial fibrillation discharged on warfarin and followed for 3 months.	Risk score=0.4(age≥70)+ 0.32(female)+ 0.58(remote bleed)+ 0.62(recent bleed)+ 0.71(alcohol/dr ug abuse)+ 0.27(diabetes) + 0.86(anemia)+ 0.32(antiplatel et use)	Hospitalization for bleeding events identified from claims data	Low (≤ 1.07)Intermediate (> 1.07 and < 2.19) High (≥ 2.19)		0.9% at 3 months2% at 3 months 5.4% at 3 months	0.9–5.7% at 12 months3.2–9.9% at 12 months 6.7–14.3% at 12 months
RIETE risk scheme (Ruiz-Gimenez, 2008) [29]	19,274 patients presenting to hospital with acute venous thromboemboli sm followed for 3 months	Recent major bleeding (<15 days prior to thrombotic event) (2 points) creatinine >1.2 mg/dL (1.5 points) anemia (1.5 points) malignancy (1 point), pulmonary embolism (1 point) age > 75 years (1 point)	Major bleeding: overt, requiring a transfusion of 2 or more units of blood, retroperitoneal , spinal, intracranial, fatal	Low (0)Intermediate (1–4) High (>4)	1340 (21%)4891 (74%) 341 (5.2%)	0.3% at 3 months2.6% at 3 months 7.3% at 3 months	0.6–4.3% at 12 months1.9–7.1% at 12 months 10.2–15.4% at 12 months
HAS-BLED (Pisters, 2010) [30]	Developed from the Euro Heart Survey on AF in 3,456 patients with atrial fibrillation followed for 12 months	1 point for each of the following: hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, or drug/alcohol use concomitantly	Major bleeding: any bleed requiring hospitalization or causing a decrease in hemoglobin level of 2 g/L or requiring blood transfusion that was not a hemorrhagic stroke	Low (0)Intermediate (1–2) High (3)	798 (N/A)2030 (N/A) 187 (N/A)	1.13 per 100 person-years2.90 per 100 person-years 3.74 per 100 person-years	0.8–2.8% at 12 months3.3–6.9% at 12 months 3.1–9.5% at 12 months
ATRIA Risk Score (Fang, 2011) [31]	Developed in 9186 atrial fibrillation patients enrolled in a large integrated healthcare system and followed for 6 years.	Anemia (3 points), severe renal disease (3 points), age ≥ 75 yrs (2 points), prior bleed (1 point), hypertension (1 point)	Potential events identified by ICD-9 CM codes and validated using chart review. Major bleeding: fatal, requiring transfusion of => 2 units blood, or hemorrhage into a critical site	Low (0–3)Intermediate (4) High (5–10)	83% person-years7% person-years 10% person-years	0.76% per 100 person-years2.62% per 100 person-years 5.76% per 100 person-years	1.5–5% per year2.1–4.6% per year 2.8–11.6% per year
ACCP 9th (Kearon, 2012) [13]	Evidence-based review of the literature	Age > 65 y, age > 75 y, previous bleeding, cancer, metastatic cancer, renal failure, liver failure, thrombocytope nia,previous stroke, diabetes, anemia, antiplatelet therapy, poor anticoagulant control, comorbidity and reduced functional capacity, recent surgery, frequent falls, alcohol abuse	N/A	Low (0)Intermediate (1) High (≥2)	N/AN/A N/A	1.6% within 3 months, 0.8% per year after the first 3 months3.2% within 3 months, 1.6% per year after the first 3 months 12.8% within 3 months, >=6.5% per year after the first 3 months	2.1% at 90 days5% at 90 days 5.2% at 90 days