Cardiology

HAS-BLED Score for Major Bleeding Risk

Estimates 1-year risk of major bleeding in patients with AFib.

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Parameters

H - Hypertension (Uncontrolled, e.g. SBP > 160 mmHg) (+1)

Yes, this condition applies to the patient

A - Abnormal Renal Function (Dialysis, transplant, Cr > 2.26) (+1)

Yes, this condition applies to the patient

A - Abnormal Liver Function (Cirrhosis, Bilirubin > 2x normal, AST/ALT > 3x normal) (+1)

Yes, this condition applies to the patient

S - Stroke History (+1)

Yes, this condition applies to the patient

B - Bleeding History or Predisposition (e.g. anemia) (+1)

Yes, this condition applies to the patient

L - Labile INRs (Unstable/high INRs or in therapeutic range < 60% of time) (+1)

Yes, this condition applies to the patient

E - Elderly (Age > 65 years) (+1)

Yes, this condition applies to the patient

D - Drugs predisposing to bleeding (e.g. NSAIDs, Antiplatelets) (+1)

Yes, this condition applies to the patient

D - Alcohol Use (≥ 8 drinks/week) (+1)

Yes, this condition applies to the patient

HAS-BLED Score for Major Bleeding Risk Result

FormulaSum of 1 point for each positive factor in the HAS-BLED mnemonic.

Clinical Pearls

Empowers clinicians to focus on modifiable bleeding risk factors rather than inappropriately denying anticoagulation to patients at high risk of stroke.

Limitations

May be less accurate for patients on newer Direct Oral Anticoagulants (DOACs), as the score was derived from cohorts largely taking Vitamin K Antagonists (Warfarin).