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RE-LY Heart Failure Subgroup Bleeding Score Calculator

  • Age (years)
  • Sex
  • History of uncontrolled hypertension (SBP >160 mmHg)?
  • Prior stroke or transient ischemic attack (TIA)?
  • History of previous major bleeding?
  • Abnormal renal function (yes = eGFR <60 mL/min/1.73 m²)?
  • Abnormal liver function (cirrhosis, AST/ALT >2x, etc)?
  • Labile INR (if on VKA) or unknown?
  • Concomitant drugs predisposing to bleeding (antiplatelets, NSAIDs)?
  • Alcohol abuse (≥8 drinks/week)?
  • Hemoglobin (g/dL) — enter if available
  • Estimated GFR (mL/min/1.73 m²) — enter if available
  • Platelet count (×10⁹/L) — enter if available
  • Malignancy (active cancer)?
  • Excessive fall risk / recurrent falls?
  • Genetic factor that increases bleeding risk (e.g., CYP2C9 variant)?
  • ABC-bleeding score (biomarker-based)
    echo "The ABC-bleeding score (Hijazi et al.) uses age, prior bleeding history and biomarkers (hemoglobin, high-sensitivity cardiac troponin, and GDF-15 or alternative renal markers). This model was shown to outperform traditional clinical scores in derivation/validation cohorts, but requires specific assays (hs-cTn, GDF-15). If you would like, provide numeric values for hs-cTnT (ng/L), GDF-15 (ng/L) and hemoglobin (g/dL) and this calculator can return an ABC estimate using published coefficients.

    Practical interpretation (RE-LY cohort context)
    In the post-hoc RE-LY analyses, HAS-BLED, ORBIT, ATRIA and HEMORR₂HAGES all stratified bleeding risk (modest discrimination). Among them, ORBIT demonstrated the best discrimination for major bleeding in the RE-LY dataset; however, all scores showed only modest c-indices (≈0.62–0.66). These tools should aid clinical judgement but do not replace individualized assessment. Consider modifiable factors (uncontrolled BP, concomitant antiplatelets/NSAIDs, alcohol, labile INR) for risk reduction.

    Note: This calculator reproduces the commonly used point-assignments for each published score and returns categorical interpretation consistent with original/validation publications. For precise predicted absolute risks (annual probabilities) use dedicated validated calculators (some scores provide continuous risk estimates) or the original publications' formulae.

    References
    Proietti M, Hijazi Z, Andersson U, Connolly SJ, Eikelboom JW, Ezekowitz MD, et al. Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the RE-LY trial. J Intern Med. 2018;283(3):282–292. DOI:10.1111/joim.12702.
    Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–1151. (RE-LY primary trial).
    O'Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36:3258–3264.
    Fang MC, Go AS, Chang Y, et al. ATRIA bleeding score derivation. J Am Coll Cardiol. 2011;58:395-401.
    Hijazi Z, Oldgren J, Lindbäck J, et al. The ABC-bleeding score: a biomarker-based model (derivation/validation). Lancet / Eur Heart J publications 2016–2018 (Hijazi et al.).
    Additional methodological context: Ferreira J, et al. Dabigatran compared with warfarin in patients with atrial fibrillation and symptomatic heart failure: a subgroup analysis of the RE-LY trial. Eur J Heart Fail. 2013.

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