24 © JAPI • februAry 2013 • VOL. 61 Abstract Objectives: To monitor the different antithrombotic drug combinations, determine the incidence, magnitude of bleeding and the association of HAS-bLeD risk scoring schema with the magnitude of bleeding as defined using TIMI bleeding criteria. Methods: A prospective observational study in a cohort of patients for a period of 8 months, at one of the tertiary care center-Krishna Institute of Medical Sciences, Hyderabad, was conducted. Consecutive patients were enrolled and followed from the date of admission till the adverse events are perceived/date of discharge. Pearson Correlation Statistics (fisher’s z Transformation) is applied to assess the association between HAS-bLeD risk factors and the total risk score with bleeding criteria. Results: A total of 400 cases were collected during the 8-month study period, of which 372 satisfied the inclusion criteria. Among them 34 (9.1%) bleeding cases were reported with mean (± SD) age of 57.8 (±14.19) years. bleeding occurred mostly in males 79.4% and a HAS-BLED Score of ≥3 has been observed in 67.6% (n=23) patients out of 34 bled patients. Two antiplatelets + One anticoagulant is the most common combination which caused bleeding in 41. 2% (n=14). Stroke history, bleeding predisposition, labile INR’s are the HAS-BLED risk factors which are significant (<0.05) with the TIMI bleeding Criteria. Conclusion: There was a linear correlation between the HAS-bLeD risk score and the TIMI bleeding criteria-higher the risk score the more frequent is the incidence of major bleeding. A HAS-BLED risk score of ≥3 is associated with TIMI major bleeding. * M Pharmacy, Department of Hospital and Clinical Pharmacy, bharat Institute of Pharmacy, Hyderabad 501510, Andhra Pradesh; # Krishna Institute of Medical Sciences, Hyderabad; ** Consultant Cardiologist, Krishna Institute of Medical Sciences, Hyderabad 500003, Andhra Pradesh; *** Assistant Professor, Department of Pharm D, bharat Institute of Pharmacy, Hyderabad 501 510, Andhra Pradesh received: 19.09.2011; Accepted: 08.11.2011 Introduction D ue to a large increase in the number of patients with thrombotic diseases- atrial fbrillation, prosthetic heart valves, cardioembolic ischemic cerebral disease, myocardial infarction, pulmonary thromboembolism and venous thromboembolism worldwide in the recent years, antithrombotic therapy is often chosen to treat such high vascular risk patients. 1 Though the antithrombotic combination treatments has improved the vascular diseases in patients, the risk of bleeding remains a signifcant issue. 2 The risk of bleeding has been evaluated in many clinical trials using various schemas like CHADS 2 score (1 point for Congestive heart failure, Hypertension, Age 75 years and older, and Diabetes, and 2 points for previous Stroke), CHA 2 DS 2 -VASc score (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65 to 74 years, Sex category), 3 HeMOrr 2 HAGeS score (Hepatic Or renal Disease, ethanol Abuse, Malignancy, Old Age (Older Than 75 years), reduced Platelet Counts Or Platelet Dysfunction, uncontrolled Hypertension, Anemia, Genetic factors, elevated fall risk, Stroke, And 2 Points for re-bleeding). 4 The new bleeding risk score HAS-bLeD (Hypertension, Abnormal renal/liver function, Stroke history, bleeding history, Labile International Normalized Ratio, Elderly, Drugs/alcohol concomitantly; 1point for each risk factor, maximum of 9 points altogether) has recently been proposed as a practical tool to assess the individual bleeding risk of real world Atrial fibrillation patients. 5 Patients with diferent risk factors receiving antithrombotic therapy are prone to bleeding, which has been proved in many clinical studies. There is a need to determine the association of various risk factors with the bleeding outcome, which can be defned using standard bleeding defnition like TIMI (Thrombolysis In Myocardial Infarction), GuSTO (Global utilisation of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) 6,7 e.t.c. The American College of Cardiology task force on clinical standards recommends that the TIMI classifcation be used as the standard. 8 The aim of this study is to monitor the incidence, magnitude of bleeding and determine the association of HAS-bLeD risk scoring schema with the magnitude of bleeding as defned using TIMI bleeding criteria. Materials and Methods A prospective observational study in a cohort of patients for a period of 8 months, from December 2010 to July 2011 at a tertiary care center-Krishna Institute of Medical Sciences, Hyderabad, was conducted. Consecutive patients were enrolled and followed from the date of admission till the adverse events are perceived/date of discharge. Study objectives are (i) To monitor the diferent antithrombotic drug combinations in a prescription (ii) To observe the incidence of bleeding after antithrombotic therapy (iii) To apply HAS-bLeD risk scoring schema in the patients experienced with bleeding (iv) To assess the magnitude of bleeding using TIMI bleeding criteria and (v) To determine the association between HAS-bLeD risk score and TIMI criteria. All the patients who were prescribed with at least one antithrombotic drug, aged above 18 years and had a hospital stay of at least 24 hours were included in the study. Patients admited to other than cardiology department were not included. Study is conducted for prescriptions that are ordered by physicians and medications administered to patients during the in-hospital stay. Data were procured using a case report form Original Article Study on Incidence of Bleeding in Hospitalized Patients after Antithrombotic Therapy at a Tertiary Care Hospital K Prudhvi * , V Daya Sagar Rao # , RK Jain # , PA Jiwani # , TNC Padmanabhan # , G Ravikanth # , VS Srinath ** , NVR Praveen Kumar Tavva *** 110 © JAPI • februAry 2013 • VOL. 61