CRUSADE Score for Post-MI Bleeding Risk

Why did you develop the CRUSADE Bleeding Score? Was there a clinical experience that inspired you to create this tool for clinicians?

Above all do no harm, yet some risks are worth taking for the benefits. The CRUSADE bleeding score is a tool to help providers consider the baseline risk of bleeding for their patients. With this, selection of bleeding reduction strategies, and increased care in dosing of adjustable anticoagulants should be considered.

What pearls, pitfalls and/or tips do you have for users of the CRUSADE Bleeding Score? Are there cases when it has been applied, interpreted, or used inappropriately?

Risk of bleeding is strongly correlated with risk of mortality. It is not the case that those with highest bleeding risk are the same patients without a benefit from anticoagulants. Rather, the opposite is often the case. Higher bleeding risk, greater benefit to be gained from treatment.
Key is in the awareness of that risk, and exercising care in dosing and treatment selection. Lower hematocrit and renal function are the most predictive items in the score.

What recommendations do you have for health care providers once they have the CRUSADE Bleeding Score result? Are there any adjustments or updates you would make to the score given recent changes in medicine?

The score was developed in a cohort treated with GPI inhibitors, lovenox, and unfractionated heparin. Very little bivalarudin and no newer antiplatelet agents were used in this cohort. The basic variables should be the same, but their relative weights may differ based upon the type of agents used.

How would you compare the CRUSADE Bleeding Score with other bleeding risk assessments for patients using anticoagulants?

The baseline variables used in the CRUSADE score are the same as in other scores. Some other scores include agents which contribute to bleeding as well. The baseline variables also vary slightly for example use of eGFR vs serum creatinine for renal function.

Karen Alexander, MD, is cardiologist at Duke University Hospital and Durham Veterans Affairs Medical Center. She is also co-director of Integrated Clinical Event and Safety Surveillance (ICE-SS) and associate professor of cardiology at the Duke Clinical Research institute (DCRI). Dr. Alexander's research focuses on cardiovascular disease management and outcomes in special populations, specifically women and the elderly.