Abstract
A patient’s history of bleeding, whether spontaneous or in response to challenges,
provides important information about both the likelihood of that patient having a
biochemically-defined hemostatic defect, and that patient’s risk of future bleeding.
Other variables including age, comorbidities and medications influence these probabilities.
Scoring systems have been devised in an effort to make the estimates quantitative
in specific populations. An example of a bleeding score is the MCMDM1-VWD questionnaire, which was developed to predict the likelihood of
a patient having von Willebrand disease. It sums standardized details of the bleeding
history, weighted by severity. The HAS-BLED score typifies bleeding prediction tools, developed to predict bleeding during anticoagulant therapy. Although prior bleeding
is one item in this score, other comorbidities like hypertension or a history of stroke
count for more. A third and related concept is that of bleeding case definitions, which are critical to standardize the reporting of outcomes in trials of antithrombotic
agents, and which have entrenched the recognition of different severities of bleeding.
We advocate that future efforts should blend some of these features. Information about
comorbidities and medication use could refine the interpretation of bleeding events
in a bleeding score. So could the introduction of a denominator reflecting the number
and duration of challenges to which the patient has been exposed when bleeding might
have been expected. More detailed information about the type, frequency and severity
of prior bleeding could improve the prognostic power of bleeding prediction tools.
More detailed history-based scores might ultimately supersede biochemical testing
in many cases.
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Article info
Publication history
Published online: July 15, 2018
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© 2018 Published by Elsevier Ltd.
