Thromboembolic And Anticoagulation Scores

Mehran 2 Bleeding Risk Score

Clinical calculation support · Verify results before clinical use

Estimate the risk of 30-day non-CABG-related major bleeding in patients presenting with acute coronary syndromes (ACS), using the integer-based ACUITY/HORIZONS-AMI model developed by Mehran et al.

Patient characteristics

Enter baseline clinical and laboratory data, ACS presentation, and anticoagulation regimen.

—Score

Demographic and laboratory variables

Use measurements obtained at presentation. Creatinine is entered in mg/dL and white blood cell count in ×10⁹/L.

Sex Female sex contributes 8 points.

Age (years) Age categories: <50, 50–59, 60–69, 70–79, and ≥80 years.

Serum creatinine (mg/dL) Enter the measured serum creatinine; do not enter eGFR.

White blood cell count (×10⁹/L) Equivalent to giga/L or 10³/µL.

Baseline hemoglobin (g/dL) Anemia: hemoglobin <13 g/dL in men or <12 g/dL in women.

ACS presentation For NSTEMI, distinguish biomarker-negative ACS from NSTEMI with elevated biomarkers as in the derivation model.

Anticoagulation regimen

The published integer score uses heparin/enoxaparin plus a GPI as the reference regimen; subtract 5 points for bivalirudin monotherapy.

Regimen used / planned

Unfractionated heparin or enoxaparin + glycoprotein IIb/IIIa inhibitor (GPI) (0 points) Bivalirudin monotherapy (−5 points)

This score's treatment adjustment should not be extrapolated to other anticoagulant combinations not represented in the original integer score.

—Mehran score

Estimated 30-day non-CABG major bleeding risk category

Complete all fields to calculate

The score and cohort event rate will appear here.

Clinical interpretation This score supports bleeding risk stratification in ACS. It does not replace clinical assessment or individualized treatment decisions.

Score component	Points
No calculation yet.

Risk categories: low (<10), moderate (10–14), high (15–19), and very high (≥20).

About the Mehran Bleeding Risk Score

The score was developed to estimate 30-day non-CABG-related major bleeding in patients with ACS. The derivation and validation dataset included 17,421 patients from the ACUITY and HORIZONS-AMI trials. The model had a c-statistic of 0.74.

The integer score combines six baseline clinical/laboratory predictors with the anticoagulation regimen. The reference score assumes heparin/enoxaparin plus a GPI; 5 points are subtracted for bivalirudin monotherapy.

Scoring components

Variable	Criterion	Points
Sex	Female	+8
Age	<50 / 50–59 / 60–69 / 70–79 / ≥80 years	0 / 3 / 6 / 9 / 12
Creatinine	<1.00 / 1.00–1.19 / 1.20–1.39 / 1.40–1.59 / 1.60–1.79 / 1.80–1.99 / ≥2.00 mg/dL	0 / 2 / 3 / 5 / 6 / 8 / 10
WBC	<10 / 10–11.9 / 12–13.9 / 14–15.9 / 16–17.9 / 18–19.9 / ≥20 ×10⁹/L	0 / 2 / 3 / 5 / 6 / 8 / 10
Anemia	Hb <13 g/dL (men) or <12 g/dL (women)	+6
Presentation	Biomarker-negative ACS / NSTEMI with elevated biomarkers / STEMI	0 / 2 / 6
Treatment	Heparin/enoxaparin + GPI / bivalirudin monotherapy	0 / −5

Risk categories and observed 30-day event rates

Score	Category	Heparin + GPI	Bivalirudin alone
<10	Low	1.9%	0.7%
10–14	Moderate	3.3%	2.0%
15–19	High	6.9%	3.7%
≥20	Very high	12.4%	8.4%

Percentages are observed cohort rates reported in the original study's risk strata, not an individualized probability generated from a continuous equation. The original study reported that the score distribution under bivalirudin monotherapy is adjusted by subtracting 5 points.

References

Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556–2566. DOI: 10.1016/j.jacc.2009.09.076.

Abu-Assi E, Raposeiras-Roubín S, García-Acuña JM, González-Juanatey JR. Bleeding risk stratification in an era of aggressive management of acute coronary syndromes. World J Cardiol. 2014;6(11):1140–1148. DOI: 10.4330/wjc.v6.i11.1140. Secondary source summarizing bleeding risk scores and scoring variables.

Model scope and limitations

Developed from ACUITY and HORIZONS-AMI trial populations with ACS managed using an invasive strategy.
Outcome: 30-day non-CABG-related major bleeding; CABG-related bleeding is not the predicted outcome.
The original paper describes the score as a practical risk tool and notes that external validation in another dataset is desirable.
Antithrombotic practice and bleeding definitions have evolved since 2010; interpret the estimate in its historical derivation context.

Clinical disclaimer: This calculator is an educational clinical decision-support aid and is not a substitute for clinical judgment. The score estimates 30-day non-CABG-related major bleeding risk in the original ACS trial context. It should not be used alone to select anticoagulant or antiplatelet therapy, determine access strategy, or withhold indicated treatment. Consider hemodynamic status, comorbidities, renal function, bleeding history, planned procedures, current guidelines, and local protocols.