RIETE Score For Bleeding Risk In Pulmonary Embolism

Determines bleeding risk in patients diagnosed with pulmonary embolism before anticoagulation therapy is initiated.

In the text below the calculator there is more information about the score and about the original study.

The RIETE score determines the risk of major bleeding in patients diagnosed with acute venous thromboembolism, DVT or PE.

The score can help clinicians weigh the benefits and drawbacks of starting the patient on anti-coagulation therapy with warfarin or other agents.

The RIETE score results from summing the points from the criteria that are present in the patient’s evaluation and ranges between 0 (no criteria) to 8 (all criteria).

The following table summarises the result interpretation, in terms of risk of major bleeding.

Score Risk level Major bleeding %
0 Low 0.1
1 Moderate 1.4
1.5 - 2 2.2
2.5 - 3 4.4
3.5 - 4 4.2
4.5 - 5 High 4.9
5.5 - 6 11
>6 20


Recent major bleeding


Anemia present (Hb <13 g/dL male, Hb <12 g/dL female)


Creatinine >1.2 mg/dL




Clinically overt PE


Age >75

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The scoring method explained

Patients suffering from pulmonary embolism or deep venous thrombosis (DVT) are required to be anticoagulated.

This is a bleeding risk stratification tool aimed at being used in the evaluation of patients diagnosed with acute venous thromboembolism events, before anticoagulant therapy like warfarin is being initiated.

The six criteria evaluated are introduced below with the number of points awarded if positive:

■ Recent major bleeding (2);

■ Anemia present (Hb <13 g/dL male, Hb <12 g/dL female) (1.5);

■ Creatinine >1.2 mg/dL (1.50);

■ Malignancy (1);

■ Clinically overt PE (1);

■ Age >75 (1).


Interpreting the result

The RIETE score distinguishes between three classes of risk: low, moderate and high. Each possible score is associated with a risk percentage of major bleeding.

Score Risk level Major bleeding %
0 Low 0.1
1 Moderate 1.4
1.5 - 2 2.2
2.5 - 3 4.4
3.5 - 4 4.2
4.5 - 5 High 4.9
5.5 - 6 11
>6 20

Anticoagulation treatment is the preferred management of pulmonary embolism, however, before initiation of therapy, individual bleeding risk needs to be evaluated.

In high risk cases, anticoagulation therapy is not an option and should be replaced with thrombolytic therapy. However, this practice is still recent and has not accrued enough statistic evidence that it improves survival, as compared to conventional anticoagulation.


About the study

Data from RIETE, an ongoing registry of consecutive patients with acute venous thromboembolism (VTE) was used in 2008 by Ruíz-Giménez et al. to compose a score to predict the risk for major bleeding within three months of anticoagulant therapy.

A cohort of 19,274 patients was enrolled, 13,057 in the derivation sample and 6,572 in the validation sample.

On multivariate analysis, age >75 years, recent bleeding, cancer, creatinine levels >1.2 mg/dl, anemia, or pulmonary embolism at baseline were found to have independent predictive value for major bleeding risk. The scores have been assigned mortality risk percentages.

The score has also been internally validated. The RIETE score can accurately determine the risk of major bleeding during anticoagulant therapy, however external validation has yet to take place.


Major hemorrhage

Major bleeding is defined in this context as overt bleeding and one of the following criteria:

■ Required transfusion of 2+ units of blood;

■ Retroperitoneal, spinal or intracranial;

■ Fatal.

This is often associated with a decline in hemoglobin concentration of at least 20 g/L.

It is important to recognize the signs of internal bleeding:

■ Bleeding from body openings such as mouth, nose or ear;

■ Vomiting blood;

■ Hemoptysis (coughing blood);

■ Cold, clammy skin;

■ Tender/ swollen stomach;

■ Pallor;

■ Sweating;

■ Bruising;

■ Dehydration;

■ Shock, weak pulse.


Original source

Ruíz-Giménez N, Suárez C, González R, Nieto JA, Todolí JA, Samperiz AL, Monreal M; RIETE Investigators. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry.Thromb Haemost. 2008; 100(1): 26-31.


Guijarro R, Montes J, Sanromán C, Monreal M; RIETE Investigators. Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry. Eur J Intern Med. 2008;19(6):443-6.

Other references

1. Monreal M, Suárez C, Fajardo JA, Barba R, Uresandi F, Valle R, Rondón P; RIETE investigators. Management of patients with acute venous thromboembolism: findings from the RIETE registry. Pathophysiol Haemost Thromb. 2004; 33(5-6):330-4.

2. Trujillo-Santos J, Prandoni P, Rivron-Guillot K, Román P, Sánchez R, Tiberio G, Monreal M; RIETE Investigators. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost. 2008; 6(2):251-5.

3. Laporte S, Mismetti P, Décousus H, Uresandi F, Otero R, Lobo JL, Monreal M; RIETE Investigators. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation. 2008; 117(13):1711-6.

Specialty: Pulmonology

System: Respiratory

Objective: Risk Prediction

Type: Score

No. Of Items: 6

Year Of Study: 2008

Article By: Denise Nedea

Published On: June 24, 2017

Last Checked: June 24, 2017

Next Review: June 24, 2023