Definitions for characterization of severity of bleeding
| Classification . | ISTH8,75,76 . | TIMI (non-CABG)9,10 . | GUSTO77 . | BARC78 . |
|---|---|---|---|---|
| Nonsurgical hemorrhages | ||||
| Major bleed | Fatal bleed and/or symptomatic plus critical organ or Hgb ↓ ≥2 g/dL or transfusion of ≥2 U red cells/whole blood | Fatal bleeding or intracranial or overt bleed with Hgb ↓ ≥5 g/dL or Hct ↓ ≥15% absolute | Severe or life-threatening: bleed that is intracranial or with hemodynamic compromise and requires intervention | Type 5a: probable fatal bleed |
| Type 5b: definite (confirmed) fatal bleed | ||||
| Type 4: CABG-related (see next) | ||||
| Type 3a: overt bleeding + Hgb ↓ 3-<5 g/dL, or any transfusion | ||||
| Type 3b: overt bleed + Hgb ↓ ≥5 g/dL, or cardiac tamponade, or requiring surgery, or intravenous vasopressors | ||||
| Type 3c: intracranial or intraocular bleed with compromised vision | ||||
| Clinically relevant nonmajor | Bleed requiring medical intervention by health care professional, or hospitalization/increased level of care, or face-to-face evaluation | Minor: clinically overt bleed + Hgb ↓ 3-<5 g/dL or Hct ↓ ≥10% No observed blood loss: Hgb ↓ ≥4 g/dL or Hct ↓ ≥12% Overt bleed requiring intervention, or leading to or prolonging hospitalization | Moderate: requires blood transfusion but no hemodynamic compromise | Type 2: any overt, actionable sign of hemorrhage + |
| (1) requiring nonsurgical, medical intervention by a health care professional, | ||||
| (2) leading to hospitalization or increased level of care, or | ||||
| (3) prompting evaluation | ||||
| Minimal | Not defined | Overt bleeding event that does not meet the criteria presented Clinically overt bleed + Hgb ↓ <3 g/dL or Hct ↓ <10% | Mild: bleeding that does not meet criteria for either severe or moderate bleeding | Type 1: bleeding that is not actionable and does not cause the patient to seek unscheduled performance of studies, hospitalization, or treatment by a health care professional; may include episodes leading to self-discontinuation of medical therapy by the patient without consulting a health care professional |
| Hemorrhages related to surgery | ||||
| Major | Fatal bleed and/or bleeding in critical organ, or extrasurgical site bleed with Hgb ↓ ≥2 g/dL or transfusion of ≥2 U red cells/whole blood Surgical site bleed requiring second intervention, or that is unexpected and prolonged and/or causes hemodynamic instability, in combination with Hgb ↓ ≥2 g/dL or transfusion of ≥2 U | CABG-related: fatal bleed, or perioperative intracranial bleed, or reoperation after closure of sternotomy for control of bleeding, or chest tube output ≥2 L/24 h | Type 4, CABG-related: perioperative intracranial bleed within 48 h, or reoperation after closure of sternotomy for control of bleeding, or transfusion of >5 U whole blood or packed cells, or chest tube output ≥2 L/24 h |
| Classification . | ISTH8,75,76 . | TIMI (non-CABG)9,10 . | GUSTO77 . | BARC78 . |
|---|---|---|---|---|
| Nonsurgical hemorrhages | ||||
| Major bleed | Fatal bleed and/or symptomatic plus critical organ or Hgb ↓ ≥2 g/dL or transfusion of ≥2 U red cells/whole blood | Fatal bleeding or intracranial or overt bleed with Hgb ↓ ≥5 g/dL or Hct ↓ ≥15% absolute | Severe or life-threatening: bleed that is intracranial or with hemodynamic compromise and requires intervention | Type 5a: probable fatal bleed |
| Type 5b: definite (confirmed) fatal bleed | ||||
| Type 4: CABG-related (see next) | ||||
| Type 3a: overt bleeding + Hgb ↓ 3-<5 g/dL, or any transfusion | ||||
| Type 3b: overt bleed + Hgb ↓ ≥5 g/dL, or cardiac tamponade, or requiring surgery, or intravenous vasopressors | ||||
| Type 3c: intracranial or intraocular bleed with compromised vision | ||||
| Clinically relevant nonmajor | Bleed requiring medical intervention by health care professional, or hospitalization/increased level of care, or face-to-face evaluation | Minor: clinically overt bleed + Hgb ↓ 3-<5 g/dL or Hct ↓ ≥10% No observed blood loss: Hgb ↓ ≥4 g/dL or Hct ↓ ≥12% Overt bleed requiring intervention, or leading to or prolonging hospitalization | Moderate: requires blood transfusion but no hemodynamic compromise | Type 2: any overt, actionable sign of hemorrhage + |
| (1) requiring nonsurgical, medical intervention by a health care professional, | ||||
| (2) leading to hospitalization or increased level of care, or | ||||
| (3) prompting evaluation | ||||
| Minimal | Not defined | Overt bleeding event that does not meet the criteria presented Clinically overt bleed + Hgb ↓ <3 g/dL or Hct ↓ <10% | Mild: bleeding that does not meet criteria for either severe or moderate bleeding | Type 1: bleeding that is not actionable and does not cause the patient to seek unscheduled performance of studies, hospitalization, or treatment by a health care professional; may include episodes leading to self-discontinuation of medical therapy by the patient without consulting a health care professional |
| Hemorrhages related to surgery | ||||
| Major | Fatal bleed and/or bleeding in critical organ, or extrasurgical site bleed with Hgb ↓ ≥2 g/dL or transfusion of ≥2 U red cells/whole blood Surgical site bleed requiring second intervention, or that is unexpected and prolonged and/or causes hemodynamic instability, in combination with Hgb ↓ ≥2 g/dL or transfusion of ≥2 U | CABG-related: fatal bleed, or perioperative intracranial bleed, or reoperation after closure of sternotomy for control of bleeding, or chest tube output ≥2 L/24 h | Type 4, CABG-related: perioperative intracranial bleed within 48 h, or reoperation after closure of sternotomy for control of bleeding, or transfusion of >5 U whole blood or packed cells, or chest tube output ≥2 L/24 h |
BARC, Bleeding Academic Research Consortium; CABG, coronary artery bypass graft; GUSTO, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries; Hct, hematocrit; Hgb, hemoglobin; ISTH, International Society on Thrombosis and Haemostasis; TIMI, Thrombolysis in Myocardial Infarction.