CALIBER Bleeding phenotype

person Phenotype Bleeding
person Type Disease or syndrome
person Data sources Primary care (CPRD), hospital admission data (HES)
person Clinical Terminologies Read, ICD-10, ICD-9, OPCS-4
person Valid event date range 01/01/1999 - 01/07/2016
person Sex Female/Male
person Agreed 23.11.2012 (Revision 2)
person Authors Laura Pasea, Sheng-Chia Chung, Mar Pujades-Rodriguez, Anoop D. Shah, Samantha Alvarez-Madrazo, Victoria Allan, James T. Teo, Daniel Bean, Reecha Sofat, Richard Dobson, Amitava Banerjee, Riyaz S. Patel, Adam Timmis, Spiros Denaxas, Harry Hemingway

Primary Care (incident)

In the Clinical Practice Research Datalink (CPRD, primary care data) we ascertained bleeding cases by searching for Read terms:


Read codeRead termCALIBER category
7004200 Evacuation of haematoma from cerebellum Haematoma
7004300 Evacuation of intracerebral haematoma NEC Haematoma
7032000 Evacuation of extradural haematoma Haematoma
7303000 Drainage of haematoma of external ear Haematoma
7303200 Drainage haematoma ext ear control cavity c bolster suture Haematoma
7736000 Evacuation of perianal haematoma Haematoma
7D05200 Evacuation of haematoma of vulva Haematoma
7G2H400 Liposuction removal of haematoma Haematoma
7G31400 Drainage of subungual haematoma Haematoma
7M0G000 Aspiration of haematoma of organ NOC Haematoma
7M0G400 Evacuation of haematoma NEC Haematoma
F503100 Haematoma of pinna Haematoma
G844.11 Perianal haematoma Haematoma
K138300 Intrarenal haematoma Haematoma
K13y800 Perirenal haematoma Haematoma
K275100 Corpus cavernosum haematoma Haematoma
K286000 Scrotal haematoma due to nontraumatic cause Haematoma
K286300 Testicular haematoma due to nontraumatic cause Haematoma
K286v00 Male genital haematoma NOS Haematoma
K31y000 Breast haematoma due to nontraumatic cause Haematoma
K537.00 Haematoma of the broad ligament Haematoma
K575.00 Haematoma of vulva Haematoma
L345.00 Vulval and perineal haematoma during delivery Haematoma
L345.11 Perineal haematoma Haematoma
L345.12 Vulval and perineal haematoma during delivery Haematoma
L345000 Vulval and perineal haematoma during delivery, unspecified Haematoma
L345100 Vulval and perineal haematoma during delivery - delivered Haematoma
L345z00 Vulval and perineal haematoma during delivery NOS Haematoma
L357.00 Obstetric trauma causing pelvic haematoma Haematoma
L357000 Obstetric pelvic haematoma unspecified Haematoma
L357100 Obstetric pelvic haematoma - delivered Haematoma
L394600 Haematoma of obstetric wound Haematoma
L443.11 Haematoma - perineal wound Haematoma
S62A.00 Traumatic extradural haematoma Haematoma
S740100 Liver haematoma and contusion without open wound into cavity Haematoma
S750100 Spleen haematoma without mention of open wound into cavity Haematoma
S751100 Spleen haematoma with open wound into cavity Haematoma
S760100 Kidney haematoma without mention of open wound into cavity Haematoma
S760111 Renal haematoma without mention of open wound into cavity Haematoma
S761100 Kidney haematoma with open wound into cavity Haematoma
SE...11 Haematoma with intact skin Haematoma
SE22300 Haematoma of rectus sheath Haematoma
SE23111 Perianal haematoma Haematoma
SE33011 Subungal haematoma Haematoma
SE33200 Contusion, fingernail (includes subungual haematoma) Haematoma
SE45.11 Haematoma of leg Haematoma
SE46.00 Traumatic haematoma Haematoma
SE4z.11 Haematoma NOS Haematoma
SE4z.12 Intramuscular haematoma NOS Haematoma
SP21.00 Peri-operative haemorrhage or haematoma Haematoma
ZA13600 Drainage of subungual haematoma Haematoma
ZA13700 Drainage of subungual haematoma with hot wire Haematoma
ZA13800 Drainage of subungual haematoma with drill Haematoma
7004100 Evacuation of haematoma from temporal lobe of brain Intracranial bleed
7008200 Aspiration of haematoma of brain tissue Intracranial bleed
7017000 Evacuation of subdural haematoma Intracranial bleed
G60..00 Subarachnoid haemorrhage Intracranial bleed
G600.00 Ruptured berry aneurysm Intracranial bleed
G601.00 Subarachnoid haemorrhage from carotid siphon and bifurcation Intracranial bleed
G602.00 Subarachnoid haemorrhage from middle cerebral artery Intracranial bleed
G603.00 Subarachnoid haemorrhage from anterior communicating artery Intracranial bleed
G604.00 Subarachnoid haemorrhage from posterior communicating artery Intracranial bleed
G605.00 Subarachnoid haemorrhage from basilar artery Intracranial bleed
G606.00 Subarachnoid haemorrhage from vertebral artery Intracranial bleed
G60z.00 Subarachnoid haemorrhage NOS Intracranial bleed
G61..00 Intracerebral haemorrhage Intracranial bleed
G61..11 CVA - cerebrovascular accid due to intracerebral haemorrhage Intracranial bleed
G61..12 Stroke due to intracerebral haemorrhage Intracranial bleed
G610.00 Cortical haemorrhage Intracranial bleed
G611.00 Internal capsule haemorrhage Intracranial bleed
G612.00 Basal nucleus haemorrhage Intracranial bleed
G613.00 Cerebellar haemorrhage Intracranial bleed
G614.00 Pontine haemorrhage Intracranial bleed
G615.00 Bulbar haemorrhage Intracranial bleed
G616.00 External capsule haemorrhage Intracranial bleed
G617.00 Intracerebral haemorrhage, intraventricular Intracranial bleed
G618.00 Intracerebral haemorrhage, multiple localized Intracranial bleed
G61X.00 Intracerebral haemorrhage in hemisphere, unspecified Intracranial bleed
G61z.00 Intracerebral haemorrhage NOS Intracranial bleed
G62..00 Other and unspecified intracranial haemorrhage Intracranial bleed
G620.00 Extradural haemorrhage - nontraumatic Intracranial bleed
G621.00 Subdural haemorrhage - nontraumatic Intracranial bleed
G622.00 Subdural haematoma - nontraumatic Intracranial bleed
G623.00 Subdural haemorrhage NOS Intracranial bleed
G62z.00 Intracranial haemorrhage NOS Intracranial bleed
G680.00 Sequelae of subarachnoid haemorrhage Intracranial bleed
G682.00 Sequelae of other nontraumatic intracranial haemorrhage Intracranial bleed
Gyu6100 [X]Other subarachnoid haemorrhage Intracranial bleed
Gyu6200 [X]Other intracerebral haemorrhage Intracranial bleed
Gyu6F00 [X]Intracerebral haemorrhage in hemisphere, unspecified Intracranial bleed
S62..12 Subarachnoid haemorrhage following injury Intracranial bleed
S62..13 Subdural haemorrhage following injury Intracranial bleed
S620.00 Closed traumatic subarachnoid haemorrhage Intracranial bleed
S621.00 Open traumatic subarachnoid haemorrhage Intracranial bleed
S622.00 Closed traumatic subdural haemorrhage Intracranial bleed
S623.00 Open traumatic subdural haemorrhage Intracranial bleed
S627.00 Traumatic subarachnoid haemorrhage Intracranial bleed
S628.00 Traumatic subdural haemorrhage Intracranial bleed
S629.00 Traumatic subdural haematoma Intracranial bleed
S629000 Traumatic subdural haematoma without open intracranial wound Intracranial bleed
S629100 Traumatic subdural haematoma with open intracranial wound Intracranial bleed
S630.12 Intracranial haematoma following injury Intracranial bleed
2BB5.00 O/E - retinal haemorrhages Intraocular bleed
2BB8.00 O/E - vitreous haemorrhages Intraocular bleed
F404500 Intra-ocular haemorrhage Intraocular bleed
F424300 Retinal pigment epithelium haemorrhagic detachment Intraocular bleed
F42y.11 Haemorrhage - retinal Intraocular bleed
F42y100 Superficial retinal haemorrhage Intraocular bleed
F42y300 Deep retinal haemorrhage Intraocular bleed
F42y400 Subretinal haemorrhage Intraocular bleed
F42y500 Retinal haemorrhage NOS Intraocular bleed
F436000 Unspecified choroidal haemorrhage Intraocular bleed
F436100 Expulsive choroidal haemorrhage Intraocular bleed
F437200 Haemorrhagic choroidal detachment Intraocular bleed
F4K2800 Vitreous haemorrhage Intraocular bleed
FyuH400 [X]Vitreous haemorrhage in diseases classified elsewhere Intraocular bleed

Primary Care (prevalent)

Prevalent cases were identified using the incident case definition (see previous section) in addition to a set of Read terms indicating historical/possible/suspected diagnosis at any point in the past.


Read codeRead termCALIBER category
14C8.00 H/O: haematemesis History of bleeding
14C9.00 H/O: melaena History of bleeding
14CA.11 H/O: GI Bleed History of bleeding
15A1.00 H/O: ante-partum haemorrhage History of bleeding
15A6.00 H/O: post-partum haemorrhage History of bleeding
7421300 Surgical arrest of postoperative bleeding of adenoid Post surgical bleeding
7517500 Surgical arrest of postoperative bleeding from tooth socket Post surgical bleeding
7531400 Surgical arrest of postoperative bleeding from tonsillar bed Post surgical bleeding
7H22600 Reopen abdo reexplore intraabd op site surg arr postop bleed Post surgical bleeding
7J01300 Reopen cranium reexploration op site arrest post op bleeding Post surgical bleeding
7M0U400 Reexploration of organ & surgical arrest postop bleeding NOC Post surgical bleeding
SP21.11 Haematoma - postoperative Post surgical bleeding
SP21.12 Haemorrhage - postoperative Post surgical bleeding
SP21100 Post-operative haemorrhage Post surgical bleeding
SP21200 Post-operative haematoma formation Post surgical bleeding
Read terms are hierarhically organized in top-level chapters i.e. chapter G....00 is related to Circulatory System Diseases and sub-headings i.e. heading G2...00 is related to Hypertensive Heart Disease while G3...00 is related to Ischaemic Heart Disease.

Secondary Care (incident and prevalent)

In Hospital Episode Statistics (HES, hospital admission data) we used ICD-10 codes (see below) for bleeding diagnosis when marked as the primary diagnosis i.e. the main condition treated or investigated during the relevant episode of healthcare. We used the date of admission to hospital as the date of the event.

Bleeding diagnoses

ICD-10 codeICD-10 termCALIBER category
N837 Haematoma of broad ligament Haematoma
O717 Obstetric haematoma of pelvis Haematoma
O902 Haematoma of obstetric wound Haematoma
T810 Haemorrhage and haematoma complicating a procedure, not elsewhere classified Haematoma
I60 Subarachnoid haemorrhage Intracranial bleed
I61 Intracerebral haemorrhage Intracranial bleed
I62 Other nontraumatic intracranial haemorrhage Intracranial bleed
I690 Sequelae of subarachnoid haemorrhage Intracranial bleed
I692 Sequelae of other nontraumatic intracranial haemorrhage Intracranial bleed
S065 Traumatic subdural haemorrhage Intracranial bleed
S066 Traumatic subarachnoid haemorrhage Intracranial bleed
H356 Retinal haemorrhage Intraocular bleed
H431 Vitreous haemorrhage Intraocular bleed
H450 Vitreous haemorrhage in diseases classified elsewhere Intraocular bleed
Post-surgical bleeding

OPCS-4 codeOPCS-4 termCALIBER category
E203 Surgical arrest of postoperative bleeding of adenoid Post surgical bleeding
F162 Surgical arrest of postoperative bleeding from tooth socket Post surgical bleeding
F365 Surgical arrest of postoperative bleeding from tonsillar bed Post surgical bleeding
T032 Reopening of chest and re-exploration of intrathoracic operation site and surgical arrest of postoperative bleeding Post surgical bleeding
T301 Reopening of abdomen and re-exploration of intra-abdominal operation site and surgical arrest of postoperative bleeding Post surgical bleeding
V032 Reopening of cranium and re-exploration of intracranial operation site and surgical arrest of postoperative bleeding Post surgical bleeding
Y321 Re-exploration of organ and surgical arrest of postoperative bleeding NOC Post surgical bleeding
A053 Evacuation of haematoma from cerebellum Haematoma
A054 Evacuation of intracerebral haematoma NEC Haematoma
A401 Evacuation of extradural haematoma Haematoma
D041 Drainage of haematoma of external ear Haematoma
H531 Evacuation of perianal haematoma Haematoma
P093 Evacuation of haematoma from vulva Haematoma
Y221 Aspiration of haematoma of organ NOC Haematoma
A052 Evacuation of haematoma from temporal lobe of brain Intracranial bleed
A103 Aspiration of haematoma of tissue of brain Intracranial bleed
A411 Evacuation of subdural haematoma Intracranial bleed
We defined fatal bleeding as a bleeding cause of death (underlying or otherwise) in the national death registry or all-cause death within 7 days of a bleeding record in primary or hospital care.
ICD-10 codeICD-10 termCALIBER category
H356 Retinal haemorrhage Death due to bleeding
H431 Vitreous haemorrhage Death due to bleeding
H450 Vitreous haemorrhage in diseases classified elsewhere Death due to bleeding
I60 Subarachnoid haemorrhage Death due to bleeding
I61 Intracerebral haemorrhage Death due to bleeding
I62 Other nontraumatic intracranial haemorrhage Death due to bleeding
I690 Sequelae of subarachnoid haemorrhage Death due to bleeding
I692 Sequelae of other nontraumatic intracranial haemorrhage Death due to bleeding
K226 Gastro-oesophageal laceration-haemorrhage syndrome Death due to bleeding
K250 Gastric ulcer ; Acute with haemorrhage Death due to bleeding
K252 Gastric ulcer ; Acute with both haemorrhage and perforation Death due to bleeding
K254 Gastric ulcer ; Chronic or unspecified with haemorrhage Death due to bleeding
K256 Gastric ulcer ; Chronic or unspecified with both haemorrhage and perforation Death due to bleeding
K260 Duodenal ulcer ; Acute with haemorrhage Death due to bleeding
K262 Duodenal ulcer ; Acute with both haemorrhage and perforation Death due to bleeding
K264 Duodenal ulcer ; Chronic or unspecified with haemorrhage Death due to bleeding
K266 Duodenal ulcer ; Chronic or unspecified with both haemorrhage and perforation Death due to bleeding
K270 Peptic ulcer, site unspecified ; Acute with haemorrhage Death due to bleeding
K272 Peptic ulcer, site unspecified ; Acute with both haemorrhage and perforation Death due to bleeding
K274 Peptic ulcer, site unspecified ; Chronic or unspecified with haemorrhage Death due to bleeding
K276 Peptic ulcer, site unspecified ; Chronic or unspecified with both haemorrhage and perforation Death due to bleeding
K280 Gastrojejunal ulcer ; Acute with haemorrhage Death due to bleeding
K282 Gastrojejunal ulcer ; Acute with both haemorrhage and perforation Death due to bleeding
K284 Gastrojejunal ulcer ; Chronic or unspecified with haemorrhage Death due to bleeding
K286 Gastrojejunal ulcer ; Chronic or unspecified with both haemorrhage and perforation Death due to bleeding
K290 Acute haemorrhagic gastritis Death due to bleeding
K625 Haemorrhage of anus and rectum Death due to bleeding
K920 Haematemesis Death due to bleeding
K921 Melaena Death due to bleeding
K922 Gastrointestinal haemorrhage, unspecified Death due to bleeding
N837 Haematoma of broad ligament Death due to bleeding
N938 Other specified abnormal uterine and vaginal bleeding Death due to bleeding
N939 Abnormal uterine and vaginal bleeding, unspecified Death due to bleeding
O031 Spontaneous abortion ; Incomplete, complicated by delayed or excessive haemorrhage Death due to bleeding
O036 Spontaneous abortion ; Complete or unspecified, complicated by delayed or excessive haemorrhage Death due to bleeding
O041 Medical abortion ; Incomplete, complicated by delayed or excessive haemorrhage Death due to bleeding
O046 Medical abortion ; Complete or unspecified, complicated by delayed or excessive haemorrhage Death due to bleeding
O051 Other abortion ; Incomplete, complicated by delayed or excessive haemorrhage Death due to bleeding
O056 Other abortion ; Complete or unspecified, complicated by delayed or excessive haemorrhage Death due to bleeding
O061 Unspecified abortion ; Incomplete, complicated by delayed or excessive haemorrhage Death due to bleeding
O066 Unspecified abortion ; Complete or unspecified, complicated by delayed or excessive haemorrhage Death due to bleeding
O071 Failed medical abortion, complicated by delayed or excessive haemorrhage Death due to bleeding
O076 Other and unspecified failed attempted abortion, complicated by delayed or excessive haemorrhage Death due to bleeding
O081 Delayed or excessive haemorrhage following abortion and ectopic and molar pregnancy Death due to bleeding
O208 Other haemorrhage in early pregnancy Death due to bleeding
O209 Haemorrhage in early pregnancy, unspecified Death due to bleeding
O46 Antepartum haemorrhage, not elsewhere classified Death due to bleeding
O67 Labour and delivery complicated by intrapartum haemorrhage, not elsewhere classified Death due to bleeding
O717 Obstetric haematoma of pelvis Death due to bleeding
O720 Third-stage haemorrhage Death due to bleeding
O721 Other immediate postpartum haemorrhage Death due to bleeding
O722 Delayed and secondary postpartum haemorrhage Death due to bleeding
O902 Haematoma of obstetric wound Death due to bleeding
P261 Massive pulmonary haemorrhage originating in the perinatal period Death due to bleeding
R041 Haemorrhage from throat Death due to bleeding
R042 Haemoptysis Death due to bleeding
R048 Haemorrhage from other sites in respiratory passages Death due to bleeding
R049 Haemorrhage from respiratory passages, unspecified Death due to bleeding
S064 Epidural haemorrhage Death due to bleeding
S065 Traumatic subdural haemorrhage Death due to bleeding
S066 Traumatic subarachnoid haemorrhage Death due to bleeding
T810 Haemorrhage and haematoma complicating a procedure, not elsewhere classified Death due to bleeding
We attempted to capture potential bleeding cases in patients with no bleeding code in primary or hospital care through the following pathways:
    • Surgical procedures (surgical arrest, haematoma evacuation) recorded in primary and hospital care
    • Transfusion with
        o Iron deficiency anaemia record in primary care or hospital within 30 days
        o Low haemoglobin (<10g/dL) and endoscopy within 30 days and no cancer, liver disease, renal disease diagnosis 1 year prior
    •	Low haemoglobin (<10g/dL) with
        o Iron deficiency anaemia record in primary care or hospital care and endoscopy within 30 days and no cancer, liver disease, renal disease diagnosis 1 year prior

Based on a combination of exploratory analyses of bleeding codes and severity markers and consensus amongst the study team we iteratively developed an algorithm to define bleeding in linked EHR. We grouped bleeding as major and minor both within primary and hospital care, or inferred.
Overlap of 39,804 bleeding recorded in CPRD (primary care), HES (hospital admissions) and ONS (death registry) and the number of inferred bleeding cases in patients without a bleeding record in primary or hospital care (n= 128,815 patients).
Five year risk of CALIBER bleeding from time of initial atrial fibrillation, acute myocardial infarction, unstable angina or stable angina (n= 128,815 patients); A: any bleeding, B: Fatal bleeding or bleeding with further markers of severity
The association between antithrombotic therapy prescribing and any bleeding and fatal or bleeding + MS events adjusted for age and sex
We found a PPV of 0.88, i.e. 88% of bleeding events identified by these codes were indeed bleeding events according to the independent review of the entire hospital record by two clinicians, blinded to the ICD-10 code assignment.
Pasea L et al. Personalising the decision for prolonged dual antiplatelet therapy: development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors. Eur Heart J. 2017 Apr 7;38(14):1048-1055. doi: 10.1093/eurheartj/ehw683. PMID: 28329300