Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

Table 1 Bleeding definitions

Trial	Definition
TIMI	Major bleeding: Intracranial hemorrhage or decrease of 5 g/dL in hemoglobin or 15% in hematocrit
	Minor bleeding: Decrease of 3 g/dL in hemoglobin with known source of blood los sor decrease of 4 g/dL in hemoglobin withoun known source of blood loss
GUSTO	Major bleeding: Fatal, intracranial, Retroperitoneal, intraocular leading to visión loss, or transfusion of 2 U
	Minor bleeding: any clinically significant bleeding not meeting major criteria leading to study drug interruption, surgery, or transfusion of 1 U of blood
ACUITY	Major bleeding: Intracranial or intraocular bleeding, hemorrhage at access site requiring intervention, hematoma ≥ 5 cm, decrease ≥ 4 g/dL of hemoglobin without overt bleeding source or ≥ 3 g/dL with source, reoperation for bleeding, or transfusion of blood product
	Minor bleeding: any clinically significant bleeding not meeting major criteria
CRUSADE	Major bleeding: intracranial hemorrhage, documented retroperitoneal bleed, hematocrit drop ≥ 12% (baseline to nadir), any red blood cell transfusion when baseline hematocrit was ≥ 28%, or any red blood cell transfusion when baseline hematocrit was < 28% with witnessed bleed
	Minor bleeding: any clinically significant bleeding not meeting major criteria
GRACE	Major bleeding: Life-threatening bleeding requiring transfusion of ≥ 2 U of packed red blood cells, bleeding resulting in absolute hematocrit decrease ≥ 10% or death hemorrhagic/subdural hematoma
	Minor bleeding: any clinically significant bleeding not meeting major criteria
BARC	Type 0: No 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
	Type 2: Any overt, actionable sign of bleeding (e.g., more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for type 3, 4, or 5 but does meet at least one of the following criteria: requiring nonsurgical, medical intervention by a health care professional; leading to hospitalization or increased level of care; or prompting evaluation
	Type 3a: Overt bleeding plus hemoglobin drop of 3-5 g/dL (provided hemoglobin drop is related to bleed), or any transfusion with overt bleeding
	Type 3b: Overt bleeding plus hemoglobin drop ≥ 5 g/dL (provided hemoglobin drop is related to bleed), or cardiac tamponade, or bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid), or bleeding requiring intravenous vasoactive agents
	Type 3c: Intracranial bleeding (does not include microbleeds or hemorrhagic transformation, does include intraspinal), or subcategories confirmed by autopsy or imaging or lumbar puncture, or intraocular bleed compromising vision
	Type 4: Coronary artery bypass graft-related bleeding, or perioperative intracranial bleeding within 48 h, or reoperation after closure of sternotomy for the purpose of controlling bleeding, or transfusion of ≥ 5 U whole blood or packed red blood cells within a 48-h period, or chest tube output ≥ 2 L within a 24-h period
	Type 5 or fatal bleeding A: Probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious
	Type 5 or fatal bleeding B: Definite fatal bleeding; overt bleeding or autopsy or imaging confirmation

ACUITY: Acute catheterization and urgent intervention triage strategy; CRUSADE: Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines; GRACE: Global Registry of Acute Coronary Events; BARC: Bleeding Academic Research Consortium.