This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Antithrombotic drugs and catheter procedures save lives after a heart attack, but they also cause bleeding, and a major bleed in hospital raises the risk of death. The CRUSADE bleeding score was derived in 2009 from more than 71,000 American patients with a non-ST-elevation myocardial infarction. It uses eight findings from admission to estimate the risk of major bleeding before discharge.
The points
| Item | Points |
|---|---|
| Baseline hematocrit | 9 (under 31%) to 0 (40% or more) |
| Creatinine clearance | 39 (15 mL/min or less) to 0 (over 120 mL/min) |
| Heart rate | 0 (70 or less) to 11 (121 or more) |
| Sex | 8 for women |
| Signs of heart failure | 7 |
| Prior vascular disease | 6 |
| Diabetes | 6 |
| Systolic blood pressure | 10 (90 or less), 1 at 121 to 180, rising again to 5 at 201 or more |
Kidney function carries the most weight because many antithrombotic drugs are cleared by the kidneys and accumulate when clearance falls. Both very low and very high blood pressure add points.
Example
A diabetic man (6) with a hematocrit of 40% (0), a creatinine clearance of 70 mL/min (17), a heart rate of 80 (1) and a blood pressure of 130 mmHg (1) scores 25: low risk, with major bleeding in 5.5% of similar patients.
Risk categories
| Score | Risk | Major bleeding in the derivation cohort |
|---|---|---|
| 20 or less | very low | 3.1% |
| 21 to 30 | low | 5.5% |
| 31 to 40 | moderate | 8.6% |
| 41 to 50 | high | 11.9% |
| over 50 | very high | 19.5% |
How it is used
CRUSADE is used with the GRACE score: GRACE estimates the ischemic risk, CRUSADE the bleeding risk. A high bleeding risk favors radial access for angiography, careful choice and dosing of anticoagulants, a proton pump inhibitor and a shorter course of dual antiplatelet therapy.
Limits
The bleeding rates come from a population treated in the early 2000s, often with femoral access. Modern practice bleeds less, so the absolute percentages overestimate today’s risk, while the ranking of patients remains useful. Creatinine clearance is calculated with the Cockcroft-Gault formula; you can work it out with our creatinine clearance calculator.