ARC HBR definition

Some risk criteria of the ARC-HBR definition are observed infrequently.

Thai PCI registry [3]

Original HBR criteria [1]

Major HBR criteria

Anticipated long-term oral anticoagulation

Severe/End-stage CKD (eGFR <30 ml/min)

Hb <11 g/dl

Spontaneous bleeding requiring hospitalization or transfusion in the past 6 mo or any time, if recurrent

Moderate/severe basline thrombocytopenia (<100x 10⁹/L)

100,000 /μL = 100 x 10⁹ /L

Chronic bleeding diathesis

Liver cirrhosis with portal hypertension

Active malignancy (excluding nonmelanoma skin cancer) within the past 12 months

Previous spontaneous ICH (at any time)/traumatic ICH (within the past 12 months)/ presence of a bAVM/ moderate or severe ischemic stroke within the past 6 mo

Nondeferrable major surgery on DAPT

Recent major surgery or major trauma within 30 day before PCI

Minor HBR criteria

Age ≥75 y

Moderate CKD (eGFR 30-59 ml/min)

Hb 11-12.9 g/dl for men and 11-11.9 g/dl for women

Spontaneous bleeding requiring hospitalization or transfusion within the past 12 mo not meeting the major criterion

Long-term use of oral NSAIDs or steroids

Any ischemic stroke at any time not meeting the major criterion

According to the ARC HBR definition, patients are considered to be at HBR if at least 1 major or more than 2 minor criteria are met

New Modified HBR criteria [3]

Major HBR criteria

Age ≥75 y

Anticipate long term oral anticoagulant

Hb <11 g/dl

Spontaneous bleeding requiring hospitalizaton or transfusion in the past 6 months

Thrombocytopenia (<100x 10⁹/L)

100,000 /μL = 100 x 10⁹ /L

Chronic bleeding diathesis

Liver cirrhosis and portal hypertension

Active malignancy

Previous spontaneous ICH/ traumatic ICH

Non-deferrable major surgery on DAPT

Recent major surgery/trauma within 30 days

Minor HBR criteria

Severe/End stage CKD (eGFR< 30 ml/min)

Hb 11-12.9 g/dl (men) or 11-11.9 g/dl (woman)

Spontaneous bleeding requiring hospitalizaton or transfusion in the past 12 months

Long term use of NSAIDs or steriods

Any ischemic stroke at any time

According to the ARC HBR definition, patients are considered to be at HBR if at least 1 major or more than 2 minor criteria are met

Simplified HBR criteria [2]

Major HBR criteria

Anticoagulation

Severe/End-stage CKD (eGFR <30 ml/min)

Hb <11 g/dl

Thrombocytopenia (<100x 10⁹/L)

100,000 /μL = 100 x 10⁹ /L

Active malignancy (excluding nonmelanoma skin cancer) within the past 12 months

Previous spontaneous ICH (at any time)/traumatic ICH (within the past 12 months)/ presence of a bAVM/ moderate or severe ischemic stroke within the past 6 mo

Minor HBR criteria

Age ≥75 y

Moderate CKD (eGFR 30-59 ml/min)

Hb 11-12.9 g/dl for men and 11-11.9 g/dl for women

Long-term use of oral NSAIDs or steroids

Any ischemic stroke at any time not meeting the major criterion

According to the ARC HBR definition, patients are considered to be at HBR if at least 1 major or more than 2 minor criteria are met

Result

Non high bleeding risk
0 major, 0 minor criteria

References

1) Philip Urban, Roxana Mehran, Roisin Colleran, Dominick J Angiolillo, Robert A Byrne, Davide Capodanno, Thomas Cuisset, Donald Cutlip, Pedro Eerdmans, John Eikelboom, Andrew Farb, C Michael Gibson, John Gregson, Michael Haude, Stefan K James, Hyo-Soo Kim, Takeshi Kimura, Akihide Konishi, John Laschinger, Martin B Leon, P F Adrian Magee, Yoshiaki Mitsutake, Darren Mylotte, Stuart Pocock, Matthew J Price, Sunil V Rao, Ernest Spitzer, Norman Stockbridge, Marco Valgimigli, Olivier Varenne, Ute Windhoevel, Robert W Yeh, Mitchell W Krucoff, Marie-Claude Morice, Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk, European Heart Journal, Volume 40, Issue 31, 14 August 2019, Pages 2632–2653, https://doi.org/10.1093/eurheartj/ehz372

2) Sato Y, Yoshihisa A, Takeishi R, Ohara H, Sugawara Y, Ichijo Y, Hotsuki Y, Watanabe K, Abe S, Misaka T, Sato T, Oikawa M, Kobayashi A, Nakazato K, Takeishi Y. Simplified Academic Research Consortium for High Bleeding Risk (ARC-HBR) Definition Predicts Bleeding Events in Patients With Heart Failure. Circ J. 2021 Dec 24;86(1):147-155. doi: 10.1253/circj.CJ-21-0686. Epub 2021 Oct 26. PMID: 34707066.

3) Roongsangmanoon W, Wongsoasup A, Chichareon P, Suwannasom P, Chandavimol M, Limpijankit T, et al. Validation of the academic research consortium high bleeding risk definition in Thai PCI registry. International Journal of Cardiology [Internet]. 2023 Oct 1;388:131167.