What is the definition of BLEED (Bleeding Classification)?

From the Guidelines

The BLEED classification system is defined as a risk assessment tool that predicts the likelihood of adverse in-hospital outcomes, including recurrent hemorrhage, need for surgery, and death, in patients with acute lower gastrointestinal bleeding, and consists of five key factors: ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status, and unstable comorbid disease. The BLEED classification system is used to triage patients with acute lower gastrointestinal bleeding into those at high risk and those at low risk of adverse in-hospital outcomes 1. This system has been proposed as a means of predicting outcome in patients hospitalized with acute lower gastrointestinal bleeding when applied at the point of initial evaluation in the emergency department 1. Key factors included in the BLEED classification system are:

• Ongoing bleeding
• Low systolic blood pressure
• Elevated prothrombin time
• Erratic mental status
• Unstable comorbid disease The use of the BLEED classification system allows for early risk stratification, which can improve patient outcomes by ensuring appropriate resource allocation and timely interventions for those at highest risk of complications 1. It is essential to note that while the BLEED classification system has been shown to be useful in predicting outcomes, other studies have suggested that artificial neural network (ANN) models may have higher predictive accuracy 1. However, the BLEED classification system remains a valuable tool in clinical practice due to its simplicity and ease of use, allowing clinicians to quickly assess patients and make informed decisions about their care.

From the FDA Drug Label

‡ Defined as clinically overt bleeding associated with a drop in hemoglobin of ≥2 g/dL, a transfusion of ≥2 units of packed red blood cells or whole blood, bleeding at a critical site, or with a fatal outcome.

‡ Defined as i) fatal bleeding, or ii) symptomatic bleeding in a critical area or organ, such as intraarticular, intramuscular with compartment syndrome, intraspinal, intracranial, intraocular, respiratory, pericardial, liver, pancreas, retroperitoneal, adrenal gland or kidney; or iii) bleeding into the surgical site requiring reoperation, or iv) bleeding leading to hospitalization.

The definition of BLEED (Bleeding Classification) is not explicitly stated in the provided text. However, based on the information provided, major bleeding can be defined as:

• Clinically overt bleeding associated with a drop in hemoglobin of ≥2 g/dL, a transfusion of ≥2 units of packed red blood cells or whole blood, bleeding at a critical site, or with a fatal outcome.
• Fatal bleeding, or symptomatic bleeding in a critical area or organ, or bleeding into the surgical site requiring reoperation, or bleeding leading to hospitalization. 2 2

From the Research

Definition of BLEED

• The BLEED classification tool is used to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage 3.
• The BLEED criteria include:
  • Ongoing bleeding
  • Low systolic blood pressure
  • Elevated prothrombin time
  • Erratic mental status
  • Unstable comorbid disease
• The BLEED classification is applied at initial emergency department evaluation and before admission to predict hospital outcomes for patients with acute upper or lower GI hemorrhage 3.

Other Bleeding Classification Tools

• Other bleeding risk assessment models have been developed, such as the HAS-BLED score, which has moderate predictive abilities for bleeding risks in patients with atrial fibrillation 4.
• The VTE-BLEED risk score is used to predict bleeding events in patients with venous thromboembolism receiving anticoagulant therapy 5.
• Other risk scores, such as the HEMORR2HAGES, ATRIA, and ORBIT scores, have also been developed to estimate bleeding risk in patients on anticoagulant therapy 6, 4, 7.