ABC-AF Bleeding Score

v2.0Biomarker-Enhanced Bleeding Risk Validation (COMBINE AF)

Laboratory Inputs

GDF-15ng/L

Key predictor (~400-800 normal)

hs-cTnTng/L

High-sensitivity Troponin T

Hemoglobing/dL

Lower levels increase risk

Ageyears

Clinical Details

Prior Major Bleeding

Anticoagulant Type

Risk Prediction

Requires complete biomarker profile (GDF-15, hs-cTnT, Hemoglobin) to calculate accurate 1-year major bleeding probability.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Quantitative bleeding risk in AF patients on oral anticoagulation (DOAC or warfarin)

To refine anticoagulation decisions where HAS-BLED or ORBIT has been insufficient

When GDF-15, hs-cTnT, and haemoglobin are available from routine laboratory platforms

Used alongside the ABC-AF Stroke Score for net clinical benefit assessment in individual patients

ESC 2020 and 2024 guidelines support biomarker-enhanced bleeding risk assessment in AF

Patient Population

Derived and validated in patients with non-valvular AF on anticoagulation. Performs consistently across subgroups including age, sex, renal function, heart failure, diabetes, and prior bleeding. Version 2.0 (2026) incorporates OAC type for treatment-specific risk estimates.

When Not to Rely on This Score Alone

GDF-15 unavailable — the score cannot be calculated without it

Valvular AF or mechanical heart valves — score not derived in these populations

Active haemorrhage — this is a chronic risk stratification tool, not an acute triage instrument

Do not withhold anticoagulation from high-stroke-risk patients based on bleeding score alone without formal net benefit analysis

Related Scores in Practice

In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the ABC-AF Stroke Score, CHA2DS2-VASc, HAS-BLED, ORBIT Score, CHADS2, HEMORR2HAGES, eGFR (CKD-EPI) or the Creatinine Clearance Multi-Method to formulate a comprehensive care plan.

Last Comprehensive Review: 2026