Bleeding Academic Research Consortium definition for bleeding

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 hemorrhage (eg, 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: (1) requiring nonsurgical, medical intervention by a health care professional, (2) leading to hospitalization or increased level of care, or (3) prompting evaluation

Type 3

Type 3a

Overt bleeding plus hemoglobin drop of 3 to <5 g/dL* (provided hemoglobin drop is related to bleed)

Any transfusion with overt bleeding

Type 3b

Overt bleeding plus hemoglobin drop ≥5 g/dL* (provided hemoglobin drop is related to bleed)

Cardiac tamponade

Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid)

Bleeding requiring intravenous vasoactive agents

Type 3c

Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal)

Subcategories confirmed by autopsy, imaging, or lumbar puncture

Intraocular bleed compromising vision

Type 4: CABG-related bleeding

Perioperative intracranial bleeding within 48 hours

Reoperation after closure of sternotomy for the purpose of controlling bleeding

Transfusion of ≥5 units whole blood or packed red blood cells within a 48-hour period^¶

Chest tube output ≥2 L within a 24-hour period

Type 5: Fatal bleeding

Type 5a

Probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious

Type 5b

Definite fatal bleeding; overt bleeding or autopsy or imaging confirmation

CABG indicates coronary artery bypass graft. Platelet tranfusions should be recorded and reported but are not included in these definitions until further information is obtatined about the relationship to oucomes. If a CABG-related bleed is not adjudicated as at least a type 3 severity event, it will be classified as not a bleeding event. If a bleeding event occurs with a clear temporal relationship to CABG (ie, within a 48-hour time frame) but does not meet type 4 severity criteria, it will be classified as not a bleeding event.

CABG: coronary artery bypass graft.
* Corrected for transfusion (1 unit packed red blood cells or 1 unit whole blood = 1 g/dL hemoglobin).
¶ Cell saver products are not counted.

Reproduced with permission from: Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123:2736. Copyright © 2011 Lippincott Williams & Wilkins.

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Bleeding Academic Research Consortium definition for bleeding