WASHINGTON, D.C. – Bleeding risk is a real concern among patients that might be candidates for anticoagulation. Should we rely on bleeding risk scores like HAS-BLED or clinical judgment? New guidelines answer that question. The American Association of Blood Loss (AABL) says to replace bleeding risk scores by simply asking the patient “Are you gonna bleed?”
Patients tend to know their bodies better than even the best of clinicians so why not put on the onus on the patient?
“HAS-BLED is a good bleeding risk score, but I’ll admit, once I get past the H for hypertension, I never know what the rest of the mnemonic stands for,” explained hospitalist Elvin Fitzpatrick. “This makes it much easier. I ask the patient, I document their answer in the chart, and it’s over and done with.”
There are many factors that can affect bleeding risk, some of which are related to the anticoagulant of choice, the others are related to the patient and his or her individual characteristics. But one overlooked factor: mood.
“If my doctor simply asked me if I would bleed on warfarin, I would have told him ‘Absolutely, I just know it,'” explained one patient, Amy Capone, who developed hematochezia shortly after starting warfarin for atrial fibrillation. “It seemed to catch all the medical professionals by surprise, but I wasn’t. I knew.”
Though the guidelines aren’t official on this, the AABL does recommend asking as a second question, “Are you gonna fall?” An answer of “Hell yes” should raise a red flag.