🩸 IMPROVE Bleeding Risk Score
Assess major bleeding risk in hospitalised medical patients with the IMPROVE bleeding score.
Score <7 lower bleeding risk; ≥7 higher major-bleeding risk.
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When to use
Weigh pharmacologic VTE prophylaxis against bleeding risk alongside IMPROVE VTE.
How it works
Age (≥85 +3.5; 40–84 +1.5) + male +1 + active ulcer +4.5 + bleed in prior 3 mo +4 + platelets <50 +4 + hepatic failure (INR>1.5) +2.5 + GFR (30–59 +1; <30 +2.5) + ICU/CCU +2.5 + CVC +2 + rheumatic disease +2 + current cancer +2.
Key points
- Score <7 lower bleeding risk; ≥7 higher major-bleeding risk.
- GFR 30–59 scores +1; <30 scores +2.5.
- Pair with IMPROVE VTE (Decousus / Spyropoulos).
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Age | 70 years |
|---|---|
| Sex | Male (+1) |
| GFR (mL/min/1.73m²) | ≥60 |
| Active gastroduodenal ulcer | No |
| Bleeding in 3 months before admission | No |
| Platelet count <50×10⁹/L | No |
| Hepatic failure (INR >1.5) | No |
| ICU/CCU stay | No |
| Central venous catheter | No |
| Rheumatic disease | No |
| Current cancer | No |
→IMPROVE Bleed2.5lower bleeding risk
- Risk：Score <7 — lower bleeding risk; still weigh with IMPROVE VTE.
- GFR：≥60 → 0; 30–59 → +1; <30 → +2.5.
| Age | 70 years |
|---|---|
| Sex | Female |
| GFR (mL/min/1.73m²) | <30 (+2.5) |
| Active gastroduodenal ulcer | Yes (+4.5) |
| Bleeding in 3 months before admission | Yes (+4) |
| Platelet count <50×10⁹/L | Yes (+4) |
| Hepatic failure (INR >1.5) | Yes (+2.5) |
| ICU/CCU stay | Yes (+2.5) |
| Central venous catheter | Yes (+2) |
| Rheumatic disease | Yes (+2) |
| Current cancer | Yes (+2) |
→IMPROVE Bleed27.5higher major-bleeding risk
- Risk：Score ≥7 — higher major bleeding risk; weigh vs VTE prophylaxis.
- GFR：≥60 → 0; 30–59 → +1; <30 → +2.5.
Frequently asked questions
- What is IMPROVE Bleeding Risk Score?
- Assess major bleeding risk in hospitalised medical patients with the IMPROVE bleeding score.
- How is IMPROVE Bleeding Risk Score calculated? What is the core formula?
- Age (≥85 +3.5; 40–84 +1.5) + male +1 + active ulcer +4.5 + bleed in prior 3 mo +4 + platelets <50 +4 + hepatic failure (INR>1.5) +2.5 + GFR (30–59 +1; <30 +2.5) + ICU/CCU +2.5 + CVC +2 + rheumatic disease +2 + current cancer +2.
- When is IMPROVE Bleeding Risk Score used?
- Weigh pharmacologic VTE prophylaxis against bleeding risk alongside IMPROVE VTE.
- What are the key clinical points for IMPROVE Bleeding Risk Score?
- Score <7 lower bleeding risk; ≥7 higher major-bleeding risk. GFR 30–59 scores +1; <30 scores +2.5. Pair with IMPROVE VTE (Decousus / Spyropoulos).
- What are the limits and cautions when using IMPROVE Bleeding Risk Score?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is IMPROVE Bleeding Risk Score calculated in practice? Can you show a worked example?
- Inputs: Age 70 years, Sex Male (+1), GFR (mL/min/1.73m²) ≥60, Active gastroduodenal ulcer No, Bleeding in 3 months before admission No, Platelet count <50×10⁹/L No, Hepatic failure (INR >1.5) No, ICU/CCU stay No… → Result: IMPROVE Bleed 2.5 lower bleeding risk（Risk: Score <7 — lower bleeding risk; still weigh with IMPROVE VTE., GFR: ≥60 → 0; 30–59 → +1; <30 → +2.5.） Inputs: Age 70 years, Sex Female, GFR (mL/min/1.73m²) <30 (+2.5), Active gastroduodenal ulcer Yes (+4.5), Bleeding in 3 months before admission Yes (+4), Platelet count <50×10⁹/L Yes (+4), Hepatic failure (INR >1.5) Yes (+2.5), ICU/CCU stay Yes (+2.5)… → Result: IMPROVE Bleed 27.5 higher major-bleeding risk（Risk: Score ≥7 — higher major bleeding risk; weigh vs VTE prophylaxis., GFR: ≥60 → 0; 30–59 → +1; <30 → +2.5.）