CRUSADE Score

Predicts risk of major bleeding in patients diagnosed with ACS, especially NSTEMI.

There is more information about the score and the original study in the text below the calculator.


The CRUSADE score is a risk stratification tool addressed to patients suffering from acute coronary syndrome: non-ST elevation myocardial infarction.

It consists in 8 patient parameters that have been validated as bleeding risk factors.

The model is particularly useful before anticoagulation therapy (preferred treatment in several cardiovascular conditions) is initiated, to weigh in the benefits and risks for the patient.


The bleeding risk is stratified in five categories, as described in the table below:

CRUSADE score Bleeding risk Rate of major bleeding
≤20 Very low 3.1%
21 - 30 Low 5.5%
31 to 40 Moderate 8.6%
41 to 50 High 11.9%
>50 Very high 19.5%

Heart rate*
Systolic BP*
Hematocrit*
Creatinine Cl*
Gender*
Signs of CHF at presentation*
History of vascular disease*
History of diabetes mellitus*
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1

Heart rate

2

Systolic blood pressure

3

Hematocrit

4

Creatinine clearance

5

Gender

6

Signs of CHF at presentation

7

History of vascular disease

8

History of diabetes mellitus

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The scoring system explained

The score evaluates to what degree are patients diagnosed with an acute coronary syndrome, especially non-ST elevation myocardial infarction, likely to suffer from a major bleeding event.

The above calculator consists of two different versions of the score to facilitate user experience. The first tab asks for values to be input (and retrieves their intervals and weights from the score) whilst the second tab asks the user to choose the range in which clinical data stands (also shows the individual weights in points).

The 8 independent bleeding risk factors from the CRUSADE score can be found in the table below:

CRUSADE item Answers (points)
Heart rate ≤70 bpm (0)
71 - 80 bpm (1)
81 - 90 bpm (3)
91 - 100 bpm (6)
101 - 110 bpm (8)
111 - 120 bpm (10)
≥121 bpm (11)
Systolic blood pressure ≤90 mmHg (10)
91 - 100 mmHg (8)
101 - 120 mmHg (5)
121 - 180 mmHg (1)
181 - 200 mmHg (3)
≥201 mmHg (5)
Hematocrit <31% (9)
≥31 and <34% (7)
≥34 and <37% (3)
≥37 and <40% (2)
≥40% (0)
Creatinine clearance ≤15 mL/min (39)
>15 and ≤30 mL/min (35)
>30 and ≤60 mL/min (28)
>60 and ≤90 mL/min (17)
>90 and ≤120 mL/min (7)
>120 mL/min (0)
Gender Female (8)
Male (0)
Signs of CHF at presentation Positive (7)
Negative (0)
History of vascular disease Yes (6)
No (0)
History of diabetes mellitus Yes (6)
No (0)

Heart rate offers information about heart work whilst the systolic blood pressure item checks the pumping function of the heart.

Hematocrit value checks the blood composition state and may be used to direct further massive transfusion. Creatinine clearance checks renal function.

Main congestive heart failure (CHF) signs are: orthopnea, dyspnea on exertion, rales, shortness of breath, jugular vein distension or chest x-ray findings.

Other causes for increased bleeding risk include:

■ Patient’s low body weight;

■ Renal impairment;

■ History of stroke;

■ Comorbidities.

The following are occurrences in major bleeding:

■ Intracranial haemorrhage;

■ Retroperitoneal bleed;

■ Hematocrit drop ≥12%;

■ Any RBC transfusion when baseline hematocrit ≥28%;

■ OR any RBC transfusion when baseline hematocrit <28% with witnessed bleed.

In patients diagnosed with NSTEMI and STEMI, antithrombotic agents are election treatment but prevention of coagulation also comes with an increase in hemorrhage risk for those patients that have other bleeding risk factors as well.

By employing scores like CRUSADE or HAS-BLED (for patients with atrial fibrillation) prior to initiating anticoagulation therapy, patient risk is stratified and the clinician may be prompted to look for alternative treatment.

 

Result interpretation

Each independent risk factor is awarded a number of points, depending on how much it contributes to increasing bleeding risk. The sum of these points is the final CRUSADE score.

Higher scores are associated with higher age and heart rate, lower systolic blood pressure, hematrocrit and creatinine clearance.

The model stratifies patients by five risk categories, presented in the table below in association to a risk percentage extracted from the original study:

CRUSADE score Bleeding risk Rate of major bleeding
≤20 Very low 3.1%
21 - 30 Low 5.5%
31 to 40 Moderate 8.6%
41 to 50 High 11.9%
>50 Very high 19.5%
 

About the study

Created by Subherwal et al. in 2009, the model was aimed at complementing current ischemic risk predictors for NSTEMI patients, with specific interest into bleeding risk.

Data from a cohort of 89,134 community-treated NSTEMI patients (derivation: 71,277, validation: 17,857) was analysed by c statistics. The treatment method was also taken into account (invasive or antithrombotic therapy).

The 8 independent baseline predictors of in-hospital major bleeding were assigned weighted integers that corresponded to the coefficient of each variable. It was found that major bleeding increased by bleeding risk score quintiles.

By using the CRUSADE score, clinicians are prompted to consider less invasive or high-risk anti-thrombotic dosage protocols in patients deemed to have a high bleeding risk.

 

Original source

Subherwal S 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):1873-82.

Validation

Abu-Assi E, Gracía-Acuna JM et al. Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) bleeding score in a contemporary Spanish cohort of patients with non-ST-segment elevation acute myocardial infarction. Circulation. 2010; 121(22):2419-26.

Other references

1. Abu-Assi E, Raposeiras-Roubin S, et al. Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2012; 1(3):222-31.

2. Erdem G, Flather M. Assessing Bleeding Risk in Acute Coronary Syndromes. Rev Esp Cardiol. 2012; 65:4-6.


App Version: 1.0.1

Coded By: MDApp

Specialty: Cardiology

System: Cardiovascular

Objective: Risk Predictor

Type: Score

No. Of Items: 8

Year Of Study: 2009

Abbreviation: CRUSADE

Article By: Denise Nedea

Published On: June 8, 2017 · 07:51 AM

Last Checked: June 8, 2017

Next Review: June 8, 2018