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Table 4 Standardized bleeding definitions

From: Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations

From clinical trials

From guidelines

BARC [66]

TIMI [39]

GUSTO [40]

ESC/EACTS 2017 [1]

Type 1: Bleeding that is not actionable and does not cause the patient to seek unscheduled performance of studies, hospitalization, or treatment by healthcare professional

Minimal: Any overt bleeding event that does not meet below criteria

Mild: Bleeding that does not meet below criteria

Trivial bleeding: Any bleeding not requiring medical intervention or further evaluation

e.g., skin bruising or ecchymosis, self-resolving epistaxis, minimal conjunctival bleeding

Type 2: Any overt, actionable sign of hemorrhage that does not fit the criteria for type 3, 4, or 5, but does meet at least one of the following criteria: (1) requiring non-surgical medical intervention by a healthcare professional, (2) leading to hospitalization or increased level of care, or (3) prompting evaluation

Minor: Clinically overt bleeding resulting in Hb drop of 3 g/dL to <5 g/dL

Moderate: Bleeding requiring blood transfusion but not resulting in hemodynamic instability

Mild bleeding: Any bleeding that requires medical attention without requiring hospitalization

e.g., not self-resolving epistaxis, moderate conjunctival bleeding, genitourinary or upper/lower GI bleeding without significant blood loss, mild hemoptysis

Type 3

3a: Overt bleeding plus Hb drop of 3 g/dL to <5 g/dL or any transfusion with overt bleeding

3b: Overt bleeding plus Hb drop ≥5 g/dL, cardiac tamponade, bleeding requiring survival intervention for control or bleeding requiring intravenous vasoactive agents

3c: Intracranial hemorrhage or intraocular bleed compromising vision

Major: Fatal bleeding, intracranial bleeding or clinically overt signs of bleeding associated with a drop in Hb of ≥5 g/dL

Severe or life-threatening: Intracranial hemorrhage or bleeding resulting in substantial hemodynamic compromise requiring treatment

Moderate bleeding: Any bleeding associated with a significant blood loss (>3 g/dL Hb) and/or requiring hospitalization, which is hemodynamically stable and not rapidly evolving

e.g., genitourinary, respiratory or upper/lower GI bleeding with significant blood loss or requiring transfusion

Type 4: CABG-related bleeding, including perioperative intracranial bleeding with 48 h, reoperation after closure of sternotomy for the purpose of controlling bleeding, transfusion of ≥5 units of whole blood or packed red blood cells within a 48 h period, chest tube output ≥2 L within a 24 h period

  

Severe bleeding: Any bleeding requiring hospitalization, associated with a severe blood loss (>3 g/dL Hb) that is hemodynamically stable and not rapidly evolving

e.g., severe genitourinary, respiratory or upper/lower GI bleeding

Type 5: Fatal bleeding

5a: Probable fatal bleeding, no autopsy or imaging confirmation but clinically suspicious

5b: Define fatal bleeding, overt bleeding, or autopsy or imaging confirmation

  

Life-threatening bleeding: Any severe active bleeding putting patient’s life immediately at risk

e.g., massive overt genitourinary, respiratory or upper/lower GI bleeding, active intracranial, spinal or intraocular hemorrhage, or any bleeding causing hemodynamic instability

  1. BARC Bleeding Academic Research Consortium, CABG coronary artery bypass graft, EACTS European Association for Cardio-Thoracic Surgery, ESC European Society of Cardiology, GI gastrointestinal, GUSTO Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries, Hb hemoglobin, TIMI Thrombosis In Myocardial Infarction