MDCalc

IMPROVE Bleeding Risk Score

Evaluates bleeding risk at hospital admission.

Use this tool to calculate the probability of major and clinically important bleeding from hospital admission to 14 days after admission. See Evidence section for important definitions.

Age, years

Gender

Renal function (GFR), mL/min/m2

Current cancer

Evidence of active malignancy within the last 6 months

Rheumatic disease

Central venous catheter

ICU/CCU

Evidence of hepatic failure (INR >1.5)

Platelet count, cells/L

Bleeding in 3 months before admission

Active gastroduodenal ulcer

Result:

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Advice
  • Consider using results in tandem with the IMPROVE or IMPROVEDD Risk Score for VTE when assessing the use of thromboprophylaxis during hospitalization.
  • Use the results of this tool to complement, not replace, clinical judgment and individualized patient assessment when deciding upon the use of anticoagulants.
Management
  • Score <7: Proceed with anticoagulation therapy, if indicated, and routine monitoring.
  • Score ≥7: 
    • Avoid anticoagulants where possible. 
    • Consider non-pharmacologic interventions. 
    • If anticoagulation therapy remains necessary, address any modifiable bleeding risk factors and closely monitor for bleeding events.
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