Thromboembolic And Anticoagulation Scores

BleeMACS Score Calculator – Major Bleeding Risk After Acute Coronary Syndrome

Clinical calculation support · Verify results before clinical use

1-Year Post-Discharge Bleeding Risk

Enter the patient's clinical characteristics and admission laboratory values.

—Score

Clinical characteristics

Age (years)

Enter age at the index ACS admission.

0–9 points

Patient age (years) Below 67 years: 0; 67–74 years: 7; 75 years or older: 9 points.

Arterial hypertension

History of hypertension diagnosed and/or treated by a physician.

+7 points

No0 points

Yes+7 points

Vascular disease

Previous stroke/transient ischemic attack (TIA) and/or peripheral artery disease (PAD).

+6 points

No0 points

Yes+6 points

Previous bleeding

Prior bleeding requiring hospitalization before the qualifying ACS, and/or serious bleeding during the index ACS admission.

+19 points

No0 points

Yes+19 points

Malignancy

Active cancer or non-active cancer treated within the previous 3 years.

+8 points

No0 points

Yes+8 points

Admission laboratory values

Hemoglobin

Use the admission hemoglobin value.

0–18 points

Hemoglobin (g/dL) 14 g/dL or higher: 0; 11–13.9 g/dL: 9; below 11 g/dL: 18 points.

Serum creatinine

Enter the admission serum creatinine. The unit can be changed without manual conversion.

0–12 points

Serum creatinine

Below 1.0 mg/dL: 0; 1.0–1.49 mg/dL: 3; 1.5 mg/dL or higher: 12 points. Conversion: 1 mg/dL = 88.4 µmol/L.

—Total score

1-year post-discharge serious bleeding risk stratum

—

Clinical interpretation

Predictor	Selected value	Points

The risk stratum is based on score quartiles in the published BleeMACS model. It is not an individualized percentage probability and should not be interpreted as a treatment recommendation.

About the BleeMACS Score

The BleeMACS score is a clinical prediction tool developed to estimate the risk of serious bleeding during the first year after hospital discharge in patients with acute coronary syndrome (ACS).

The original model was derived in an international registry of 15,401 patients with ACS who underwent PCI. External validation was performed in the SWEDEHEART registry, including patients treated with and without PCI.

Predictor definitions

Hypertension: physician-diagnosed and/or treated hypertension.
Vascular disease: previous stroke/TIA and/or peripheral artery disease.
Previous bleeding: bleeding requiring hospitalization before the qualifying ACS, and/or serious bleeding during the index ACS admission. The original definition included TIMI major/minor, GUSTO moderate/severe, or BARC type 3 bleeding.
Malignancy: active cancer or non-active cancer treated during the previous 3 years.
Laboratory variables: admission hemoglobin and serum creatinine.

Score interpretation

Total score	Risk stratum
≤7	Very Low Risk
8–16	Low Risk
17–24	Moderate Risk
≥25	High Risk

These categories represent score quartiles reported for the BleeMACS model. They are not absolute bleeding-risk percentages.

Model performance

Derivation cohort: C-statistic 0.71 (95% CI 0.68–0.74).
Internal validation: C-statistic 0.72 (95% CI 0.67–0.76).
External SWEDEHEART validation: 0.65 (95% CI 0.64–0.66) in PCI patients and 0.63 (95% CI 0.62–0.64) in non-PCI patients.

References

Raposeiras-Roubín S, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. International Journal of Cardiology. 2018;254:10–15.
doi:10.1016/j.ijcard.2017.10.103

Application of Modern Clinical Risk Scores in the Global Assessment of Risks Related to the Diagnosis and Treatment of Acute Coronary Syndromes in Everyday Medical Practice. International Journal of Environmental Research and Public Health. 2021;18(17):9103.
Full text (PMC)

2026 ACC Scientific Statement on Antiplatelet Therapy in the Management of Atherosclerotic Cardiovascular Disease. Journal of the American College of Cardiology. 2026.
doi:10.1016/j.jacc.2026.05.037

Important limitations

The model estimates post-discharge bleeding over one year; it is not an in-hospital bleeding score.
The derivation cohort consisted of patients who underwent PCI. External validation included patients with and without PCI.
External discrimination was more modest than in the derivation cohort.
Contemporary antithrombotic regimens and current practice may differ from the 2003–2014 registry era.
The score should be considered alongside clinical assessment and other applicable bleeding-risk frameworks.

Clinical disclaimer: The BleeMACS score is a prognostic risk-stratification instrument and must not be used as the sole basis for antithrombotic selection, dose, or duration. The result does not replace clinical judgement, assessment of active bleeding, evaluation of ischemic risk, or guideline-based decision-making. Confirm the input definitions and laboratory units before interpreting the result.