Definition of major bleeding used by US anticoagulation clinics.

摘要

Clinical practices in reporting bleeding likely differ between anticoagulation clinics. As a result, the collation and reporting of bleeding rates is problematic. Available definitions of major bleeding are inconsistent and are not uniformly employed. For example, the Thrombolysis in Myocardial Infarction (TIMI) criteria, define major bleeding as an intracranial haemorrhage, a decrease in hematocrit of 15% or a 5 g/dl decrease in the haemoglobin concentration.1 Both the TIMI criteria and the Global Use of Strategies to Open Occluded arteries (GUSTO) criteria are specifically used to describe bleeding in acute care settings and in patients exposed to intravenous antith-rombotic therapy [1,3]. Comparatively, the definition recommended by the International Society on Thrombosis and Haemostasis (ISTH) defines major bleeding as fatal bleeding; symptomatic bleeding in a critical area or organ such as intracranial, intraspinal, intraocular resulting in vision changes, retroperitoneal, intraarticular, pericardial, or intramuscular with compartment syndrome; bleeding causing a fall in hemoglobin level of 2-g/dL or more; and/or bleeding leading to transfusion of two or more units of whole blood or red cells.3 Both the ISTH criteria and the definition used by Italian Study of Complications of Anticoagulant Therapy (ISCOAT) incorporate more detailed criteria to describe major bleeding in patients taking chronic warfarin therapy on an outpatient basis [2,4].