Bleeding Academic Research Consortium

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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In order to harmonize and create a universal definition of bleeding, the Bleeding Academic Research Consortium (BARC) was convened. Dr. C Michael Gibson chaired the subcommittee drafting the definition of bleeding types 0, 1 and 2; Dr. Gabriel Stegg chaired the subcommittee drafting the definition of bleeding types 3a and 3b; Dr. Harvey White chaired the subcommittee drafting the definitions of coronary artery bypass grafting bleeding; and Dr. Deepak Bhatt chaired the subcommittee on fatal bleeding. The committee was chaired by Dr. Roxana Mehran and Dr. Sunil Rao.

## BARC Definition (DO NOT EDIT)

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Bleeding Academic Research Consortium (BARC) definition for Bleeding: [1]

“  |

### Type 0:

* No bleeding

### Type 1:

* Bleeding that is not actionable and does not cause the patient to seek unscheduled performance of studies, hospitalization, or treatment by a health-care professional; may include episodes leading to self-discontinuation of medical therapy by the patient without consulting a health-care professional.

### Type 2:

* Any overt, actionable sign of hemorrhage (e.g., more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for type 3, 4, or 5 but does meet at least one of the following criteria:

* requiring nonsurgical, medical intervention by a health-care professional,
* leading to hospitalization or increased level of care, or
* prompting evaluation

### Type 3:

##### Type 3a:

* Overt bleeding plus hemoglobin drop of 3 to < 5 g/dL* (provided hemoglobin drop is related to bleed)
* Any transfusion with overt bleeding

##### Type 3b:

* Overt bleeding plus hemoglobin drop ≥5 g/dL* (provided hemoglobin drop is related to bleed),
* Cardiac tamponade,
* Bleeding requiring surgical intervention for control (excluding dental/nasal/skin/hemorrhoid),
* Bleeding requiring intravenous vasoactive agents

##### Type 3c:

* Intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal),
* Subcategories confirmed by autopsy or imaging or lumbar puncture,
* Intraocular bleed compromising vision.

### Type 4:

* CABG-related bleeding,
* Perioperative intracranial bleeding within 48 h,
* Reoperation after closure of sternotomy for the purpose of controlling bleeding
* Transfusion of ≥ 5 U whole blood or packed red blood cells within a 48-h period,
* Chest tube output more than or equal to 2L within a 24-h period

### Type 5:

* Fatal bleeding

##### Type 5a:

* Probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious

##### Type 5b:

* Definite fatal bleeding; overt bleeding or autopsy or imaging confirmation

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## References

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1. ↑ Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J; et al. (2011). "Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium". Circulation. 123 (23): 2736–47. doi:10.1161/CIRCULATIONAHA.110.009449. PMID 21670242.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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