For healthcare professionals
CRUSADE bleeding score calculator
The CRUSADE bleeding score adds points for eight findings at hospital admission to estimate the risk of major bleeding during the hospital stay in patients with non-ST-elevation myocardial infarction (NSTEMI). This tool is written for clinicians and is not a diagnosis.
Findings at admission
Use the values at hospital presentation. Nothing you enter leaves this page.
Not known? Work it out with the creatinine clearance calculator.
What you will see
The total CRUSADE score (1 to 96) with the band and points for each item, the risk group (very low to very high) and the in-hospital major bleeding rate printed for that group.
Educational only, not medical advice. Not a diagnosis. Decisions belong to the treating team.
Source
The CRUSADE bleeding score by Subherwal S and colleagues, Circulation 2009, with every band, point, risk group and bleeding rate as printed in the open access review by Gawinski and colleagues, International Journal of Environmental Research and Public Health 2021, and the points cross-checked band by band against Table 1.6 of the 2021 Brazilian Society of Cardiology guideline (Nicolau and colleagues, Arquivos Brasileiros de Cardiologia); both CC BY 4.0. The tests check every band edge, each yes or no item, the lowest and highest possible score and the 20, 30, 40 and 50 group edges.
Validated in
Patients with non-ST-elevation myocardial infarction in the CRUSADE registry: as printed by Gawinski and colleagues, a derivation cohort of 71,277 and a validation cohort of 17,857 patients. We do not describe the original paper further, because it is not open access.
Limits
Discrimination was moderate (c statistic 0.71 in derivation, 0.70 in validation). The score does not include age directly (only through creatinine clearance), the treatment strategy or the number of antithrombotic drugs. The rates are those seen in the five groups of the original registry, not a personal prediction. The Brazilian guideline prints whole-number bands (for example 16 to 30 mL/min, under 70 per minute); we use the edges printed by Gawinski and colleagues (over 15 to 30 mL/min, 70 or less per minute), which give every value one band. Hematocrit between two printed bands (for example 33.95%) is placed in the lower band.
The point table
CRUSADE bleeding score, as printed by Gawinski and colleagues 2021 (Gawinski 2021) and in Table 1.6 of the Brazilian guideline (Nicolau 2021) (Subherwal 2009):
- Baseline hematocrit (%): under 31, 9; 31 to 33.9, 7; 34 to 36.9, 3; 37 to 39.9, 2; 40 or more, 0
- Creatinine clearance (mL/min, Cockcroft-Gault): 15 or less, 39; over 15 to 30, 35; over 30 to 60, 28; over 60 to 90, 17; over 90 to 120, 7; over 120, 0
- Heart rate (per minute): 70 or less, 0; 71 to 80, 1; 81 to 90, 3; 91 to 100, 6; 101 to 110, 8; 111 to 120, 10; 121 or more, 11
- Sex: male, 0; female, 8
- Signs of heart failure at presentation: no, 0; yes, 7
- Prior vascular disease (prior stroke or peripheral artery disease): no, 0; yes, 6
- Diabetes: no, 0; yes, 6
- Systolic blood pressure (mmHg): 90 or less, 10; 91 to 100, 8; 101 to 120, 5; 121 to 180, 1; 181 to 200, 3; 201 or more, 5
Gawinski and colleagues describe signs of heart failure as exertional breathlessness, orthopnea, labored breathing, fatigue, rales over more than a third of the lung fields, raised jugular venous pressure, an S3 gallop or pulmonary congestion on x-ray thought to be cardiac (Gawinski 2021).
Worked example: a woman (8) with diabetes (6), hematocrit 35% (3), creatinine clearance 45 mL/min (28), heart rate 95 (6) and systolic pressure 110 mmHg (5), with no signs of heart failure and no prior vascular disease, scores 56 points, the very high risk group.
Reading the result
The score is split into five groups: very low (20 or less), low (21 to 30), moderate (31 to 40), high (41 to 50) and very high (over 50). In the CRUSADE study, in-hospital major bleeding occurred in 3.1%, 5.5%, 8.6%, 11.9% and 19.5% of patients in these groups (Gawinski 2021). The Brazilian guideline notes that age is not an item, though it enters through the creatinine clearance (Nicolau 2021). Bleeding risk is weighed against ischemic risk, for which see the TIMI risk score and the HEART score.
Related tools
For contrast kidney injury after PCI, see the Mehran score; for bleeding risk on anticoagulation in atrial fibrillation, the HAS-BLED score and the ORBIT bleeding score. Kidney function: the creatinine clearance calculator. Other bedside scores are listed under For healthcare professionals.
To grade heart failure at the bedside in acute myocardial infarction, see the Killip classification (class I to IV).
Sources
- Gawinski L, Engelseth P, Kozlowski R. Application of modern clinical risk scores in the global assessment of risks related to the diagnosis and treatment of acute coronary syndromes in everyday medical practice. Int J Environ Res Public Health. 2021;18(17):9103. doi:10.3390/ijerph18179103. PMID 34501692. Open access (CC BY 4.0). Section on the CRUSADE bleeding score (points, quintiles and in-hospital major bleeding rates). pmc.ncbi.nlm.nih.gov/articles/PMC8431105/
- Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHM, Precoma DB, Lemke W, et al. Brazilian Society of Cardiology guidelines on unstable angina and acute myocardial infarction without ST-segment elevation, 2021. Arq Bras Cardiol. 2021;117(1):181-264. doi:10.36660/abc.20210180. PMID 34320090. Open access (CC BY 4.0). Table 1.6 (CRUSADE bleeding risk score). pmc.ncbi.nlm.nih.gov/articles/PMC8294740/
- Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009;119(14):1873-1882. doi:10.1161/CIRCULATIONAHA.108.828541. PMID 19332461. Original score (cited, not quoted). pubmed.ncbi.nlm.nih.gov/19332461/
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