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ATRIA Bleeding Risk Score

ATRIA predicts major hemorrhage on warfarin in atrial fibrillation (0–10 points): anemia 3, severe renal disease 3, age ≥75 2, prior hemorrhage 1, hypertension 1. Low risk 0–3 (0.8%/yr), intermediate 4 (2.6%/yr), high 5–10 (5.8%/yr).

Age (years)
Anemia (Hb <13 g/dL men, <12 g/dL women) (yes/no, +3)
Severe renal disease (eGFR <30 mL/min or dialysis) (yes/no, +3)
Any prior hemorrhage diagnosis (yes/no, +1)
Diagnosed hypertension (yes/no, +1)

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Interpretation

Result	Meaning
0–3	Low: 0.8%/yr
4	Intermediate: 2.6%/yr
5–10	High: 5.8%/yr

Formula

Anemia 3 · severe renal disease (eGFR <30 or dialysis) 3 · age ≥75 2 · any prior hemorrhage 1 · hypertension 1 (max 10)

Clinical pearls

Derived in warfarin-treated AF patients; DOAC-era bleeding rates are generally lower.
A high bleeding score is a prompt to fix modifiable risks (BP, anemia workup, concomitant antiplatelets), not by itself a reason to withhold anticoagulation.

Examples

atria bleeding score 80 yo with anemia and htn atria for 68 year old on dialysis with prior gi bleed warfarin bleeding risk atria 77F hypertension

FAQ

ATRIA or HAS-BLED?

HAS-BLED is more widely used in guidelines; ATRIA had a higher c-index in its derivation cohort. Both mainly serve to flag modifiable bleeding risk.

What counts as anemia in ATRIA?

Hemoglobin below 13 g/dL in men or below 12 g/dL in women.

Evidence

Fang MC et al. A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA Study. J Am Coll Cardiol 2011;58:395–401.

Cardiology · Reviewed 2026-10-14 · Methodology