CRUSADE Score for Bleeding Risk Calculator

How does this CRUSADE score for bleeding risk calculator work?

This is a health tool designed to assess the risk of major bleeding in patients under acute coronary syndromes, especially NSTEMI. It is based on the original study with the 8 baseline factors that have been validated in order to provide a risk assessment and stratification tool but also guidelines for patients.

This CRUSADE score for bleeding risk calculator has two tabs comprising of two different versions so the clinicians and not only can choose which of the versions is fitted in their case. The first tab allows the user to input data freely in the first four fields while the second tab asks the user to simply choose the range in which the clinical data stands from an array of answers in the first four questions.

The first part of the calculator contains clinical determination results, including bleeding risk factors as explained below:

■ Heart rate – measured in beats per minute, with values ranging from below 70 to above 121, offers information on the heart work.

■ Systolic blood pressure – measured in mmHg, with values ranging from below 90 to above 200, provides guidance in regard to the pumping function of the heart and blood circulation.

■ Hematocrit – in %, useful in determining the current blood composition state and any data that could be used in case a massive transfusion would be needed at some point.

■ Creatinine clearance – measured in mL/min, with the range between below 15 and above 120, offering information about the creatinine levels and the kidney extraction function.

The other four questions in the CRUSADE score focus on the major risk factors:

■ Gender – risk factor suggesting that females are at higher risk than males in this situation.

■ Signs of CHF at presentation – positive for signs of congestive heart failure including orthopnea, shortness of breath, dyspnea on exertion, rales, jugular vein distension or chest x-ray findings.

■ History of vascular disease & History of diabetes mellitus – these are the main risk factors in most major cardiac events and are also considered to increase risk of hemorrhage significantly.

Apart from the causes of increased bleeding detailed above there are others such as low body weight, renal impairment, history of stroke or other pharmacological treatments for comorbidities.

As antithrombotic agents are election treatment for patients with NSTEMI and STEMI, a lot of attention has been put into finding means of assessing bleeding risk associated with this treatment. The first study was based on patient with non-ST elevation while another validation study focused on STEMI cases and the risk score performed similarly.

Such models that stratify baseline hemorrhage risk can offer information on outcomes in patients with acute coronary syndromes ACS and other heart disease, especially prior to anticoagulation therapy being put in place and can allow clinicians to set alternative treatment routes for patients deemed as high risk.

The only criticism given to the score is that utility might decrease when patient receive more than 2 antithrombotic agents.

CRUSADE score interpretation

The result is based on an assigned weighted integer given to each independent factor answer, based on the overall coefficient in the score.

A higher risk is associated with higher age, heart rate and low systolic blood pressure with lower hematocrit and lower creatinine clearance.

There are five groups of risk as stratified by the model and based on the bleeding score obtained:

■ Very low risk: ≤20.

■ Low risk: 21 to 30.

■ Moderate risk: 31 to 40.

■ High risk: 41 to 50.

■ Very high risk: >50.

References

1) Subherwal S, Bach RG, et al. (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation; 119(14):1873-82.

2) Abu-Assi E, Gracía-Acuna JM et al. (2010) Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) bleeding score in a contemporary Spanish cohort of patients with non-ST-segment elevation acute myocardial infarction. Circulation; 121(22):2419-26.

3) Erdem G, Flather M. (2012) Assessing Bleeding Risk in Acute Coronary Syndromes. Rev Esp Cardiol; 65:4-6.

4) Abu-Assi E, Raposeiras-Roubin S, et al. (2012) Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome. Eur Heart J Acute Cardiovasc Care; 1(3):222-31.