ARC-HBR Criteria (High Bleeding Risk after PCI)

The ARC-HBR criteria (Academic Research Consortium for High Bleeding Risk, Urban and colleagues 2019) define high bleeding risk in patients undergoing percutaneous coronary intervention.

Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.

Example

Sex
male
Age
80 years
Hemoglobin
14 g/dL
eGFR
45 mL/min
Platelet count
250 x10^9/L
Prior spontaneous bleeding
No prior spontaneous bleeding requiring hospitalization or transfusion
Prior ischemic stroke
No previous ischemic stroke
Anticipated long-term oral anticoagulation
No
Chronic bleeding diathesis
No
Liver cirrhosis with portal hypertension
No
The other 7 values
Active malignancy within 12 months, excluding non-melanoma skin cancer
No
Previous SPONTANEOUS intracranial hemorrhage, AT ANY TIME
No
Previous TRAUMATIC intracranial hemorrhage within 12 months
No
Brain arteriovenous malformation
No
Non-deferrable major surgery expected while on dual antiplatelet therapy
No
Major surgery or major trauma within 30 days before PCI
No
Long-term oral NSAIDs or corticosteroids
No

Result: High bleeding risk

The tool opens with these values already filled in. Replace them with your own.

What the result means

Common error
A widely used calculator states the rule as "at least 1 major", which misses every patient qualifying on minors alone.
Banding
Anemia, eGFR, prior bleeding and prior stroke are BANDED across major and minor - NOT separate criteria. The same patient cannot be both.
Anemia
Under 11 g/dL MAJOR (both sexes). Minor band 11-12.9 men, 11-11.9 women. SEX MATTERS ONLY IN THE MINOR BAND.
eGFR
Under 30 MAJOR; 30-59 MINOR.
Platelets
Under 100 x10^9/L MAJOR.
Age
75 or over MINOR.
Timing
SIX different windows: 6 months, 6-12 months, 12 months, any time, 30 days. Do not carry one across the set.
Target
A DEFINITION, not a score: BARC 3-5 bleeding at or above 4% or ICH at or above 1% at 1 year. Counts are provenance, not severity.
Scope
Bleeding risk only. Does NOT weigh against ischemic risk. Not an instruction to shorten DAPT or drop an agent.

What you enter

  • Sex.
  • Hemoglobin.
  • eGFR.
  • Platelet count.
  • Age.
  • Prior spontaneous bleeding.
  • Prior ischemic stroke.
  • Anticipated long-term oral anticoagulation.
  • Chronic bleeding diathesis.
  • Liver cirrhosis with portal hypertension.
The other 7 fields
  • Sex. Used ONLY for the anemia MINOR band (11 to 12.9 for men, 11 to 11.9 for women). The major anemia threshold is the same for both.
  • Hemoglobin. BANDED: under 11 is MAJOR, the sex-specific band above it is MINOR, and the same patient cannot be both.
  • eGFR. BANDED: under 30 is MAJOR, 30 to 59 is MINOR.
  • Platelet count. Under 100 is a MAJOR criterion.
  • Age. 75 or over is a MINOR criterion.
  • Prior spontaneous bleeding. BANDED across major and minor by TIMING [none = no criterion; within-6-months-or-recurrent = major; six-to-twelve-months = minor]
  • Prior ischemic stroke. BANDED across major and minor [none = no criterion; moderate-severe-within-6-months = major; other-ischemic-any-time = minor]
  • Anticipated long-term oral anticoagulation. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Chronic bleeding diathesis. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Liver cirrhosis with portal hypertension. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Active malignancy within 12 months, excluding non-melanoma skin cancer. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Previous SPONTANEOUS intracranial hemorrhage, AT ANY TIME. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Previous TRAUMATIC intracranial hemorrhage within 12 months. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Brain arteriovenous malformation. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Non-deferrable major surgery expected while on dual antiplatelet therapy. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Major surgery or major trauma within 30 days before PCI. A MAJOR criterion: one alone makes the patient high bleeding risk.
  • Long-term oral NSAIDs or corticosteroids. A MINOR criterion: two minor criteria together make the patient high bleeding risk.
How this is calculated
Rule
1 MAJOR criterion OR 2 MINOR criteria. Two minor are worth one major, so minor criteria ALONE can qualify a patient.

Urban P, Mehran R, Colleran R, et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Circulation. 2019;140(3):240-261. Read the source ↗

A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.

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Built by Clay Good. Source on GitHub.