STEEPLE bleeding criteria

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

Steeple Bleeding Criteria (DO NOT EDIT)[1]

Safety and Efficacy Of Enoxaparin In Percutaneous Coronary Intervention Patients: An International Randomized Evaluation Major Bleeding

  • Fatal bleeding
  • Retroperitoneal, intracranial, or intraocular bleeding
  • Bleeding that causes hemodynamic compromise requiring specific treatment
  • Bleeding that requires intervention (surgical or endoscopic) or decompression of a closed space to stop or control the event
  • Clinically overt bleeding, requiring any transfusion of ≥1 U PRBC or whole blood
  • Clinically overt bleeding, causing a decrease in hemoglobin of ≥3 g/dL (or, if hemoglobin level is not available, a decrease in hematocrit of ≥10%)


  • Gross hematuria not associated with trauma (eg, from instrumentation)
  • Epistaxis that is prolonged, is repeated, or requires plugging or intervention
  • Gastrointestinal hemorrhage
  • Hemoptysis
  • Subconjunctival hemorrhage
  • Hematoma >5 cm or leading to prolonged or new hospitalization
  • Clinically overt bleeding, causing a decrease in hemoglobin of 2 to 3 g/dL
  • Uncontrolled bleeding requiring protamine sulfate administration


  1. Stone GW, Midei M, Newman W, Sanz M, Hermiller JB, Williams J; et al. (2009). "Randomized comparison of everolimus-eluting and paclitaxel-eluting stents: two-year clinical follow-up from the Clinical Evaluation of the Xience V Everolimus Eluting Coronary Stent System in the Treatment of Patients with de novo Native Coronary Artery Lesions (SPIRIT) III trial". Circulation. 119 (5): 680–6. doi:10.1161/CIRCULATIONAHA.108.803528. PMID 19171853.

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