University of Oulu

Brascia, D., Onorati, F., Reichart, D., Perrotti, A., Ruggieri, V. G., Santarpino, G., … Biancari, F. (2017). Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score. Thrombosis and Haemostasis, 117(3), 445–456.

Prediction of severe bleeding after coronary surgery : the WILL-BLEED risk score

Saved in:
Author: Biancari, Fausto1; Brascia, Debora1; Onorati, Francesco2;
Organizations: 1Department of Surgery, Oulu University Hospital, Oulu, Finland
2Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
3Hamburg University Heart Center, Hamburg, Germany
4Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
5Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
6Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
7Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
8Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK
9Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
10Centro Cuore Morgagni, Pedara, Italy
11Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
12Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
13Division of Cardiac Surgery, University of Genoa, Genoa, Italy
14Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
15Department of Cardiac Surgery, Centro Cardiologico–Fondazione Monzino IRCCS, University of Milan, Italy
16Heart Center, Turku University Hospital, Turku, Finland
17Division of Cardiac Surgery, University of Parma, Parma, Italy
18National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Thieme, 2017
Publish Date: 2019-10-22


Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2–3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m² (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0–3: 2.9 % vs 3.4 %; scores 4–6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.

see all

Series: Thrombosis and haemostasis
ISSN: 0340-6245
ISSN-E: 2567-689X
ISSN-L: 0340-6245
Volume: 117
Issue: 3
Pages: 445 - 456
DOI: 10.1160/TH16-09-0721
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2019 Georg Thieme Verlag KG. This is an Accepted Manuscript of an article that was published in Thrombosis and Haemostasis. The Definitive Version of Record can be found online at: