ARC-HBR High Bleeding Risk Calculator

The Academic Research Consortium for High Bleeding Risk (ARC-HBR) developed a consensus definition to identify patients undergoing percutaneous coronary intervention (PCI) who are at high risk of bleeding on antithrombotic therapy. The definition combines major and minor clinical criteria spanning anticoagulant use, renal function, hematologic parameters, prior bleeding or hemorrhagic stroke, malignancy, and recent major surgery or trauma.

A patient meets the HBR definition if ≥ 1 major criterion OR ≥ 2 minor criteria are present. This calculator implements that rule numerically by assigning 2 points to each major criterion and 1 point to each minor criterion, with an HBR threshold of ≥ 2 points. This reproduces the original logic: a single major criterion (2 points) or two minor criteria (1 + 1 = 2 points) both cross the threshold.

Four clinical domains (hemoglobin, chronic kidney disease, ischemic stroke, and spontaneous bleeding) each have a major and a minor version defined by severity or timing. Only the single most severe applicable version of each should be selected, since the major and minor versions of the same domain are not meant to be counted together.

• Before elective or urgent PCI, to assess whether a patient meets high bleeding risk criteria
• When planning the duration and intensity of dual antiplatelet therapy (DAPT) after stent implantation
• When deciding between standard-duration and shortened/de-escalated antithrombotic regimens
• When reviewing modifiable bleeding risk factors that could be corrected before or after PCI

Major: long-term oral anticoagulant (OAC) use

Chronic use of an oral anticoagulant (vitamin K antagonist or direct oral anticoagulant) for any indication.

Major: severe/end-stage CKD (eGFR < 30 mL/min)

eGFR < 30 mL/min. Do not also select the minor moderate CKD criterion.

Major: hemoglobin < 11 g/dL

Hemoglobin below 11 g/dL. Do not also select the minor hemoglobin criterion.

Major: spontaneous bleeding requiring hospitalization and/or transfusion within the past 6 months

Spontaneous bleeding requiring hospital admission and/or blood transfusion within the last 6 months. Do not also select the minor 12-month bleeding criterion.

Major: thrombocytopenia (platelet count < 100 ×10⁹/L)

Platelet count below 100 ×10⁹/L.

Major: chronic bleeding diathesis

Known chronic bleeding diathesis.

Major: liver cirrhosis with portal hypertension

Liver cirrhosis with portal hypertension.

Major: active malignancy within the past 12 months

Active malignancy diagnosed or treated within the past 12 months.

Major: history of spontaneous intracranial hemorrhage (at any time)

Any prior spontaneous intracranial hemorrhage, at any point in the patient's history.

Major: traumatic intracranial hemorrhage within the past 12 months

Traumatic intracranial hemorrhage within the past 12 months.

Major: brain arteriovenous malformation

Presence of a cerebral arteriovenous malformation.

Major: moderate/severe ischemic stroke within the past 6 months

Moderate or severe ischemic stroke within the past 6 months. Do not also select the minor "any ischemic stroke" criterion.

Major: urgent major surgery on dual antiplatelet therapy (DAPT)

Urgent major surgery performed while the patient is on dual antiplatelet therapy.

Major: major surgery or trauma within 30 days before PCI

Major surgery or trauma within the 30 days preceding PCI.

Minor: age ≥ 75 years

Age 75 years or older.

Minor: moderate CKD (eGFR 30-59 mL/min)

eGFR 30-59 mL/min.

Minor: hemoglobin 11-12.9 g/dL (men) or 11-11.9 g/dL (women)

Hemoglobin 11-12.9 g/dL in men or 11-11.9 g/dL in women.

Minor: spontaneous bleeding requiring hospitalization/transfusion within 12 months (not meeting major criterion)

Spontaneous bleeding requiring hospitalization or transfusion within the past 12 months, not meeting the major criterion.

Minor: long-term NSAID or corticosteroid use

Long-term use of NSAIDs or corticosteroids.

Minor: any history of ischemic stroke (not meeting major criterion)

Any history of ischemic stroke, not meeting the major (moderate/severe, within 6 months) criterion.

• ARC-HBR is a consensus-based categorical definition (HBR vs non-HBR); the point system used in this calculator is an implementation aid and not part of the original published scoring.
• The criteria were developed to flag bleeding risk and were not designed to also quantify ischemic risk; any decision to shorten or de-escalate DAPT must be balanced against thrombotic risk.
• Overlapping criteria (hemoglobin, CKD, stroke, and bleeding) must each be scored only once, using the most severe applicable category.
• The tool reflects the criteria as defined in the consensus document and does not capture bleeding risk factors outside this list.