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Risk assessment for
bleeding complications
The assessment of the overall risk of bleeding will depend on the INR, (where we know the relative
risk increases significantly and exponentially from an INR of 4), and patient risk factors outlined
Risk is a spectrum and your clinical decisions should be guided by all patient factors and INR. Risk
factors can be additive. Patients with two or three risk factors have a much higher incidence of
warfarin-associated bleeding than those with none or one.
The reversal guidelines use low and high risk as criteria when considering patient factors, low would
be where there are no risk factors listed below and high one or more.
Risk Factor Category
Specific Risk Factors
> 65 years
Uncontrolled hypertension (SBP >160mmHg)
History of gastrointestinal haemorrhage, active peptic ulcer
disease, hepatic insufficiency, high alcohol ingestion ( 8
drinks/week). Liver disease (cirrhosis, bilirubin >2x normal,
AST/ALT/AP >3x normal)
Thrombocytopenia (platelet count < 50 x109 / L), platelet
dysfunction, coagulation defect, underlying malignancy. Prior
history of sever haemorrhage. Predisposition to bleeding
(antiplatelets, NSAIDs, COX-1 inhibitors)
History of stroke, cognitive or psychological impairment
Renal insufficiency, dialysis, transplant, creatinine >200 mol/L
Recent trauma or major surgery in previous 2 weeks, history of
falls (> 3 within previous treatment year, recurrent or injurious
Aspirin, antiplatelets, COX-1 inhibitors.
Amiodarone, antibiotics, anticonvulsants and some
complementary medicines may have caused the raised INR and
may make correction and control difficult
Unstable or high INRs. Time in the therapeutic range < 60%
Haematological / Oncological
Labile INR
Link to the HAS BLED Calculator
Developed by the ECI from “Warfarin reversal: consensus guidelines on behalf of the Australasian Society of Thrombosis and
Haemostasis” Ross I Baker, Paul B Coughlin, Alex S Gallus, Paul L Harper, Hatem H Salem and Erica M Wood,2004, Medical Journal of
Australia, 181(9), 492-497
Updated June 2016