IMPROVE Bleeding Score

Thirteen-factor bleeding score from the IMPROVE registry (Decousus 2011) for acutely ill medical inpatients considered for thromboprophylaxis. A score ≥ 7 marks high bleeding risk (major bleeding about 10 times higher), favouring mechanical prophylaxis. Use with Padua or IMPROVE VTE.

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Age

Renal function (GFR)

Additional criteria

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Total score

Lower bleeding risk

In-hospital major bleeding ≈ 0.4% (major or clinically relevant ≈ 1.5%) at 14 days

Decision guide

Pharmacological prophylaxis can be given when VTE risk is high (Padua ≥ 4 or IMPROVE VTE ≥ 2).

2 sections are still unanswered — counted as 0 points.

Ranges: 0–6.5 Lower bleeding risk7–30 High bleeding risk

References

Decousus H, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 2011;139:69-79.
Rosenberg DJ, et al. External validation of the IMPROVE Bleeding Risk Assessment Model in medical patients. Thromb Haemost 2016;116:530-536.
Schünemann HJ, et al. ASH 2018 guidelines for management of VTE: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018;2:3198-3225.